1. Full Name:^*

2. Previous Name (s):

3. Preferred Pronouns:^*

4. Phone Number:^*

5. What is Your Email Address?^*

6. Home Address:^*

7. How long have you resided at this address?^*

8. Have you moved from another state in the last three years?^*

9. If yes, what was your prior address?

10. If you have a different Mailing Address, please provide below

11. Are you currently employed or retired?^*

12. If currently employed, please provide your employer, postion and dates of employment below

13. How did you find Law Offices of Peter N. Wasylyk?^*

14. Has Law Offices of Peter N. Wasylyk represented you in any other matters?^*

15. If yes, please describe all prior or current representations:

16. If you are related to or have a prior relationship with any attorney at Law Offices of Peter N. Wasylyk please describe the nature of the relationship

17. To the best of your knowledge, how did RIBridges get your personal information?^*

18. What information do you recall providing to RIBridges? ^*

19. How did you first find out about the data breach (breach notice, online etc)? ^*

20. Did you receive a letter or notification regarding the data breach?^*

21. If yes, when did you receive the letter?

22. Do you still have a copy of the letter or notification?^*

23. If you don't have a copy of the letter, please explain why

24. If you did not receive a letter, why do you think you were affected by the data breach?

25. What type of information do you believe was affected in the breach and why?

26. Did you pay for credit monitoring or any other form of identity theft prevention after learning of the data breach? ^*

27. If yes, what type of protection?

28. What company did you use?

29. What type of subscription do you have (monthly / annual)?

30. How much do you pay for service (monthly / annually)?

31. If no, why did you choose not to purchase credit monitoring?

32. Did you pay for a credit freeze?^*

33. Did you pay for credit monitoring or any other form of identity theft prevention after learning of the data breach?^*

34. Since December 5, 2024, have you noticed any suspicious activities?^*

35. Were accounts opened under your name without authorization?^*

36. If yes, what kind of account(s) were opened without your authorization?

37. Do you have any documents (e.g., emails, letters, credit report) regarding the fraudulent account?^*

38. If fraudulent accounts were open, what you did to resolve the account?

39. Do you have documentation of any other fraud or identity theft?^*

40. Have you received any notification that your information has been found on the dark web?^*

41. How and when did you find out about the unauthorized activity?

42. Were you charged any money or made responsible for charges made on account?

43. If yes, How much?

44. Is the account closed?

45. What did you do after discovering the fraud?

46. How many hours and/or how much money did you spend to address the fraud? Please itemize to the best of your ability.

47. Do you have any documents (e.g., emails, letters, credit report) regarding the fraudulent account and what you did to resolve the account?

48. If no, please explain why:

49. Why do you believe this fraudulent account is related to the data breach?

50. Has someone filed or attempted to file a false tax return in your name for the 2024 tax year?^*

51. Which tax returns?

52. Were you expecting a refund?

53. If yes, how much were you expecting?

54. Have you received your refund?

55. How long was your refund delayed for?

56. Has the IRS and/or State resolved its investigation?

57. If yes, what did the IRS and/or State find?

58. What did you do after discovering the fraud?

59. How many hours and/or how much money did you spend to address the fraud? Please itemize to the best of your ability.

60. Do you have any documents (e.g., emails, letters to and from IRS) about the tax fraud and what you did to resolve the fraud?

61. If not, please explain why:

62. How do you typically file your tax returns?

63. Why do you believe the tax fraud is related to the data breach?

64. Any notification that your information has been found on the dark web?

65. Any other fraud or identity theft?

66. Before December 5, 2024, have you ever experienced any instances of identity theft, fraud, or credit issues?^*

67. If yes, what kind of fraud?

68. When did this fraud occur?

69. How was it resolved?

70. Have you experienced any emotional impact resulting from the breach (for example, concern that your personal information would be exposed)? ^*

71. If yes, please explain.

72. Have you experienced any personal impact resulting from the breach (for example, an interference in personal affairs, relationships, or other matters)?^*

73. If yes, please explain.

74. Did you spend time or expense addressing the data breach or searching for fraudulent activity?^*

75. If yes, please estimate the hours you spent and itemize activities:

76. Please describe and itemize expenses incurred (includes postage, gas):

77. Did you spend time on the phone with Deloitte, RIBridges, or their affiliates trying to learn about the breach?

78. If yes, please explain.

79. Did you spend money out of pocket to address the Data Breach? If yes, explain?

80. Since December 5, 2024 have you received notification from any company that your personal information or health information may have been exposed? ^*

81. If yes, which company?

82. Did you suffer any harm as a result of these breaches?

83. If so, please explain in detail:^*

84. Do you still have the notification informing you of the data breach?

85. If not, please explain why:

86. Have you or your spouse spoken with any media members about the data breach? ^*

87. If yes, please provide the following, Media outlet, date of conversation and summary of conversation:

88. Was the converstaion published in any medium?

89. If yes, do you have the link to the publication?

90. What social media accounts do you maintain?

91. Have you ever posted about the data breach?^*

92. If yes please provide, Date of post(s), Content of (posts), Privacy settings at time of post(s), and Current privacy settings:

93. Is the post still accessible?

94. If yes, please provide a screenshot or print out of the post.

95. If not, please explain why:

96. The letter of notification regarding this data breach sent by the State of Rhode Island

97. Accounts opened under your name without authorization

98. Fraudulent charges on any accounts

99. The filing of a false tax return in your name for the 2024 tax year.

100. Notification from any company that your personal information or health information may have been exposed Since December 5, 2024

Posts you have made about the data breach