Vivint FCRA Settlement

VIVINT, INC. CLASS ACTION SETTLEMENT
PROOF OF CLAIM FORM

TO RECEIVE A PAYMENT FROM THE SETTLEMENT FUND, YOU MUST COMPLETE THIS CLAIM FORM AND SUBMIT IT BY JUNE 7, 2024, AND IT MUST ALSO BE VALIDATED THROUGH THE CLAIMS ADMINISTRATION PROCESS.

INSTRUCTIONS

IMPORTANT NOTE: You must submit this Claim Form as stated in Step 5 below by June 7, 2024, or with a postmark date of no later than June 7, 2024, in order for its validity to be considered to receive payment. To complete this Claim Form, read the instructions below in Step 1; provide the requested information in Step 2; sign the certification in Step 3; provide the optional supporting documentation in Step 4; and submit the completed Claim Form electronically or by mail as outlined in Step 5.

Each Settlement Class Member may submit only one Claim Form regardless of the number of times you believe Vivint, Inc. (“Vivint”) accessed your credit information, the number of accounts that may have been opened without authorization, or the number of collection efforts you may have been subjected to. Settlement Class Members are eligible to receive compensation for each account that was opened without authorization and each account subjected to collections. However, Settlement Class Members can only receive payment for an account once. Submitting more than one Claim Form will not increase your compensation under the Settlement Agreement. After a valid Claim Form is submitted, the Settlement Administrator will utilize Vivint’s records and third-party records to determine the amount each eligible Settlement Class Member is actually entitled to receive under the terms of the Settlement Agreement.

STEP 1 – INSTRUCTIONS

In the spaces below in Steps 2 and 3, provide your (i) name, (ii) date of birth, (iii) address(es), (iv) email, (v) phone number, (vi) unique ID number, if applicable, and (vii) provide your responses to each of the certifications in Step 3. Remember that only credit accesses, account creations, or collection efforts by Vivint occurring between January 1, 2016, and January 16, 2024, are eligible for a claim.

STEP 2 – REQUIRED CLAIMANT INFORMATION

Name *

Date of Birth: *

Current Street: *

Current City: *

Current State: *

Current Zip: *

Email Address: *

Phone Number: *

All address(es) you have been associated with from January 1, 2016, to January 16, 2024:

Prior Street: *

Prior City: *

Event State: *

Prior Zip Code: *

Must Click Add To Submit Your Info.

Prior Street

City

State

Zip Code

Action

STEP 3 – REQUIRED CERTIFICATION

During the period of January 1, 2016, through January 16, 2024, I was a Vivint Customer. If yes, please answer the following questions:

In addition to the accounts above, if any, I believe that Vivint opened an account using my name or credit information without my authorization during the period of January 1, 2016, through January 16, 2024.

I believe that I was subjected to collection efforts by Vivint regarding unauthorized accounts that were opened in my name from January 1, 2016, through January 16, 2024.

I certify, UNDER PENALTY OF PERJURY, that all the above statements are TRUE AND ACCURATE to the best of my knowledge. I understand that the Settlement Administrator and the Parties have the right to verify my responses or otherwise dispute any claims that are based on inaccurate responses.

Select Day Of Week For Filing: *

Signature: *

STEP 4 – OPTIONAL SUPPORTING DOCUMENTATION

If you checked any of the boxes in Step 3 above, and you possess any supporting documentation, please attach to this Claim Form (either by attaching .pdfs, if submitting electronically via the settlement website or by email, or by including a hard copy print out, if you are submitting this Claim Form by mail) all documentation you contend evidences the fact Vivint accessed your credit, created an account in your name without authorization, or made collection efforts against you. Documentation may include screen shots, emails, letters, credit report print outs, or call records. Submitting documentation to support your claim is NOT required, but it can assist the Settlement Administrator in determining the validity and/or value of your claim.

All supporting documentation for your positions and transactions should be uploaded to this page prior to moving on to the next step in your online claim submission.

Please use the browse option, by clicking on “Select Files” in the box below, to upload your supporting documentation being submitted to verify all of your positions and transactions.

Select files

Files To Be Uploaded	Size	Action