Levine v. Citibank N.A.

Filing 173

PRELIMINARY APPROVAL ORDER. The deadline to submit a claim, to object, and to opt out is January 31, 2013. The Final Approval Hearing shall be held on March 15, 2013. Signed by Judge Maxine M. Chesney on November 6, 2012. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C) (mmclc1, COURT STAFF) (Filed on 11/6/2012) Modified on 11/6/2012 (mmclc1, COURT STAFF).

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CLAIM FORM In re Citibank HELOC Reduction Litigation Submit this Claim Form Online at https://www.inrehelocsettlement.com or return this Claim Form to: In re Citibank HELOC Litigation, Settlement Administrator PO Box 2838, Portland, OR 97208-2838, Questions? Visit https://www.inrehelocsettlement.com or call 1-866-487-6522 DEADLINE: THIS CLAIM FORM MUST BE SUBMITTED ONLINE OR POSTMARKED BY JANUARY 31, 2013 Instructions: Mail this form only if all of the following are true. You: (1) were a Citibank HELOC customer during the period from January 1, 2008 through January 31, 2012; (2) closed your HELOC account in response to Citibank’s suspension or reduction of your HELOC based on Citibank’s claim that your home value significantly declined in value; and (3) paid an early closure release fee to Citibank. Each person seeking a cash benefit under the Class Action Settlement Agreement must complete a paper claim form. You can only submit one claim form for each HELOC you closed in response to Citibank’s suspension or reduction of your HELOC account. Only former named account holders may file a claim form. Where there are multiple accountholders named on a single account, only one claim form may be filed. If any co-borrower on your account requests to be excluded from the Settlement, the claim will be deemed invalid. For further information, please visit www.inrehelocsettlement.com, or call 1-866-487-6522 To submit a claim for a cash benefit, begin by filling in all of the information requested in Part A. Once complete, move on to Part B and check each and every box that applies to you. Once all of the boxes are checked, review and sign the Certification under Part C. After the form is completed, submit it online at https://www.inrehelocsettlement.com or mail it to the Settlement Administrator at In re Citibank HELOC Litigation, Settlement Administrator, PO Box 2838, Portland, OR 97208-2838. All claim forms must be submitted online or postmarked by January 31, 2013. PART A - CLAIMANT INFORMATION* Name: _______________________________ (First) ________ (Middle) _________________________________ (Last) Address: ________________________________________________________________________ (Street) ________________________________________ ____ ____ ____ ____ ____ ____ ____ (City) (State) (Zip Code) Phone Number: ( ___ ___ ___) ___ ___ ___ – ___ ___ ___ ___ Address of property serving as security for Citibank HELOC (if different from address above): _______________________________________________________________________________________ (Street) ________________________________________ ____ ____ ____ ____ ____ ____ ____ (City) (State) (Zip Code) Contact Phone Number: ( ___ ___ ___) ___ ___ ___ – ___ ___ ___ ___ Please provide a phone number where you can be reached if further information is required. Email Address: ____________________________________________ * All information in this section is required. PART B – EARLY CLOSURE RELEASE FEE INFORMATION Cash Refund for Payment of Early Closure Release Fee By submitting a claim form, I verify that I believe I am a member of the Class and that the following statements are true: I was a Citibank HELOC customer in the United States, and my HELOC was suspended or reduced by Citibank based on a claim that my home value significantly declined. As a result of Citibank’s suspension or reduction of my HELOC, I closed my HELOC account. In closing my Citibank HELOC account, I paid Citibank an early closure release fee. Failure to check all three boxes may result in the denial of your claim. PART C – CERTIFICATION UNDER PENALTY OF PERJURY I declare under penalty of perjury that I believe I am a member of the Class, and all of the information in this Claim Form is true and accurate. Signature: _________________________________ Date: _________________________________ Print Name: ________________________________ If approved you will be entitled to a cash award of $120.00. Questions? Visit https://www.inrehelocsettlement.com or Call 1-866-487-6522

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