Check Your Address. Please note any changes to your name or address information in the space provided next to your pre-populated name and address.
2.
Fill out Part I of the Claim Form and provide the Settlement Administrator with tax reporting information. As explained in the Class Notice, part of the Individual Settlement Amount you receive will be paid as non-wages and you will receive an IRS Form 1099 for this amount. You need to provide us with a Form W-9 or fill out the substitute Form W-9 information below so that the amounts may be reported to the Internal Revenue Service and applicable state taxing authority. Part of the Individual Settlement Amount will also be paid and reported as wages on an IRS Form W-2. You may provide the Settlement Administrator with a Form W-4, a copy of which is enclosed. If you do not do so, taxes will be withheld and reported based on the single rate.
3.
Provide information about a deceased Class Member in Part II, if applicable. If the employee to whom this Class Notice is addressed is deceased, you need to provide a death certificate to the Claims Administrator and documentation showing that you are the court-appointed estate representative or if there is no court appointed representative, documentation showing you are the surviving spouse, the surviving child, or the surviving parents of the employee to whom the Class Notice is addressed. We also may need to contact you for additional information so please make sure you include current contact information on this Claim Form.
4.
Sign and Date the Form. The Claim Form must be completed and signed personally by the current or former employee of The Driver Provider who would like to receive payment of an Individual Settlement Amount as explained in the Class Notice or by someone with a legal right to act on behalf of the Class Member to whom the Class Notice is addressed
5.
Complete and Return the Form By Mail, Email, or Online. Please read carefully and complete the Claim Form. You may do so on this online form, or email a scanned copy of a completed form to DriverProviderSettlement@atticusadmin.com.
