Submit a Claim

Opt-Out Form

Claimant Information

To complete your Opt Out Request Form, please fill out this form completely and sign below.

Claimant Type*

Please provide the Unique ID from your Notice, if applicable.

Unique ID

Are you/the Claimant being represented by your/their own attorney?*

YesNo

Contact Information

Country

Address 1

Address 2

City

Zip Code

Phone

Email

Certification & Signature

By checking this box, I confirm that I/the Claimant am/is a Class Member in Bhatia v. Silvergate Bank et al, Case No. 3:2023-cv-01406, and that I would like to be excluded from the Settlement.*

By typing your name below and clicking the “Submit” button, I acknowledge that I/the Claimant will be excluded from the Settlement.

Signature

Date