Full Name:^*

Phone Number:^*

What is Your Email Address?^*

Home Address:^*

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

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

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

Did you freeze your credit?^*

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

Were accounts opened under your name without authorization?^*

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

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

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

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

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

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

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

If yes, what kind of fraud?

Any documents—physical and electronic (including emails)—must be provided to us:

Are you aware of any potentially relevant documents, electronic or otherwise, that are no longer accessible by you?

If yes, please describe in detail: