DAWN TARDIBUONO-QUIGLEY, on behalf of herself and all others similarly situated,
Plaintiff,

v.


HSBC MORTGAGE CORPORATION (USA) and HSBC BANK USA, N.A.,
Defendants.


Case No. 7:15-cv-06940-KMK-JCM

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK

Please review the Notice you received by postal mail for your Notice ID and Confirmation Code, which are the codes that appear above your address in the Notice you received by mail.

Please remember to enter the full Notice ID exactly as it appears on your personalized notice, including any letters.

If you can’t locate your Notice ID and Confirmation Code, please email the Settlement Administrator at info@MortgageDefaultSettlement.com for verification.

The deadline for submitting this proof of claim form is APRIL 8, 2020

1. Your name:

If your name has changed, please email the Settlement Administrator at info@MortgageDefaultSettlement.com or call 1-877-720-6290.

Note that only one settlement payment will be issued for each property, even where more than one borrowing party signed the operative mortgage or security agreement. The settlement payment will be issued to the person named here and that person shall be solely responsible for the allocation of the payment between and among any co- borrowers. In the event that more than one claim is received for a single property, the settlement payment will be issued to the person listed on the first-submitted claim.

2. The address of the residential property for which you entered into a mortgage or security agreement with HSBC Mortgage Corporation (USA) or HSBC Bank USA, N.A. (together, “HSBC”), and for which you were assessed fees by HSBC for property inspections and/or broker price opinions:

3. Your current preferred mailing address:

4. Your current preferred phone number and e-mail address:

* Required Fields

5. You must certify the following declaration:

I HEREBY ACKNOWLEDGE that (a) plaintiff and defendants in the above-captioned action have consented to the jurisdiction of the Court for purposes of hearing and determining plaintiff’s motions for preliminary and final approval of the Settlement Agreement and Settlement, and, if approved, for all proceedings related to the implementation, enforcement and administration of the Settlement Agreement; (b) by submitting this Proof of Claim, I am submitting to the jurisdiction of the Court to hear and determine this matter for all proceedings relating to my submission; and (c) by submitting this Proof of Claim, I will be deemed, upon the Effective Date, to have released the Released Claims against the Released Parties, pursuant to the terms of the Judgment to be entered if the Settlement Agreement and Settlement are approved.

I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. EXECUTED ON THE DATE SET FORTH BELOW.

6. You must complete an IRS Form W-9 (available here) and submit that form with your claim, in accordance with the instructions below, to receive an award.

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    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).

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    First Name
    Last Name
    HSBC Property Street Address
    HSBC Property City
    HSBC Property State
    HSBC Property Zip Code
    Street Address
    City
    State
    Zip Code
    Phone Number
    Email Address
    Signature
    Date

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

    Click here to edit your Claim.