Request For Exclusion

If you do not follow these procedures and deadlines, you will remain a Settlement Class Member and lose any opportunity to exclude yourself from the Settlement. This means that your rights will be determined in this lawsuit by the Settlement Agreement if it receives final approval from the Court.

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Certification:
 By checking this box, I hereby request to be excluded from the Settlement Class in (Yvonne Belanger v. Allstate Fire and Cas. Ins. Co., et al., Case No. 1:19-CV-00317-WJ-SCY). I understand that I will not be bound by any of the Court’s orders or judgments in this Settlement and will not get any money or benefits from the Settlement.*

PLEASE ONLY COMPLETE THIS CERTIFICATION IF YOU WISH TO OPT OUT OF THIS SETTLEMENT.