Carpenter v. Allstate Insurance Company

Case No. 2:21-cv-03381-EAS-EPD

UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO

If you received a personalized notice in the mail or via email with a Claim ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Claim ID exactly as it appears on your personalized Notice, (i.e. 12345678).

The deadline for submitting this proof of claim form is January 14, 2022


I. Provide Your Contact Information:
* Required Fields
II. PHONE NUMBER ON WHICH YOU RECEIVED A CALL OR CALLS:

Your phone number must be listed in our records as one of the phone numbers that was called by AGAX Leads on behalf of Allstate included as part of the settlement. If you are not certain which of your phone numbers may have been called, you may list each of them separately.

III. Fill Out and Sign the Following Attestation:

By submitting this Claim Form, I certify that I received call(s) seeking to sell Allstate insurance products or services.

Your Claim Form has been submitted successfully.

HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@AICTCPAClassAction.com.

Please print this page for your records.

Your Claim Details

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
Last Name
Street Address 1
Street Address 2
City
State
Zip Code
Email Address
Contact Phone Number
Call Phone Number 1
Call Phone Number 2
Call Phone Number 3
Signature
Date

If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@AICTCPAClassAction.com

Click here to edit your Claim.