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

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

The deadline for submitting this proof of claim form is

Please add the email, Confirmation@usdollarliborsettlement.com, to your contact list to ensure that future correspondence is delivered to your inbox.

Contact Information

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Transactions

To submit your claim, please download the template below and fill in the required information for each transaction.

When complete, upload your file using the upload tool below.

Supporting Documentation

Accepted file types are: PDF, TIF, JPG, GIF, PNG, CSV. Other file types will be rejected.

Please confirm in the grid below that your file has been successfully uploaded.

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    Fill Out and Sign the Following Attestation

    I declare under penalty of perjury under the laws of the United States that I am a Class Member (as defined in the Class Notice), and that the information in this Claim Form and any documentation attached to it are true and correct to the best of my knowledge. If I did not provide required documents, it is because I do not have them.

    Your Claim Form has been submitted successfully.

    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
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Phone Number
    Signature
    Date

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

    Click here to edit your Claim.

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