Form Ca8168 – Fill Out and Use This PDF

Bank of America TCPA Settlement	Toll Free Number:		1-877-919-9186
Claims Administrator	Website:	www.BOATCPASettlement.com
PO Box 3410	Email:	info@BOATCPASettlement.com
Portland OR 97208-3410	Objection/Exclusion Deadline:		March 21, 2014
	Settlement Fairness Hearing:		April 4, 2014
	Deadline to File a Claim:		March 21, 2014

BANK OF AMERICA TCPA SETTLEMENT CLAIM FORM

Settlement Awards shall be made to eligible Settlement Class Members on a claims-made basis. Each member of the Settlement Class shall be entitled to make a Claim for a Settlement Award. Any Settlement Class Member shall be entitled to make one claim each for any Mortgage Calls and one claim for Credit Card Calls or Credit Card Texts. (For example, a person who received Mortgage Calls and Credit Card Calls may make two claim selections by checking the appropriate box in Part II and Part III of this claim.) To make a claim, Settlement Class Members must complete and submit a claim by March 21, 2014.

PART I: CLAIMANT IDENTIFICATION:

First Name

Last Name

Address 1 (street name and number)

Address 2 (apartment, unit or box number)

City

State

Zip Code

Foreign Country (only if not USA)

Optional Telephone Number (home)

– –

Email address

Cell phone number at which you received one or more non-emergency mortgage or credit card default servicing calls using an automatic telephone dialing system and/or an artiicial prerecorded voice (“Automatic Calls”) or one or more non-emergency default servicing text messages (“Automatic Texts”) without your prior express consent:

Unique Identiier

Please enter the 13 digit unique identiier published in the postcard notice or email notice that you received. If you did not receive a notice, or cannot locate the 13 digit unique identiier, you may leave this ield blank.

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PART II: CLAIM TYPE: AUTOMATIC CREDIT CARD TEXTS OR CALLS:

If you received one or more Automatic Calls or Texts regarding a Bank of America Credit Card Account, you can make a claim for either Automatic Credit Card Calls or Automatic Credit Card Texts, but not both, by checking the appropriate box below:

Received one or more AUTOMATIC CALLS regarding a Bank of America Credit Card Account between May 16, 2007, and January 31, 2013; OR

Received one or more AUTOMATIC TEXTS from Bank of America regarding a Bank of America Credit Card Account between February 22, 2009, and December 31, 2010.

NOTE: YOU CANNOT MAKE A CLAIM FOR BOTH AUTOMATIC CREDIT CARD TEXTS AND AUTOMATIC CREDIT CARD CALLS

PART III: CLAIM TYPE: AUTOMATIC MORTGAGE CALLS:

If you received one or more Automatic Calls regarding a Bank of America Residential Mortgage Loan Account, you can make a claim for Automatic Mortgage Calls by checking the box below:

Received one or more Automatic Calls from Bank of America regarding a Bank of America Residential Mortgage Loan Account between August 30, 2007 and January 31, 2013.

PART IV: CERTIFICATION:

By submitting this claim form, I certify that the foregoing information supplied by the undersigned is true and correct.

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