ELECTRONIC REQUEST FOR EXCLUSION FROM CLASS SETTLEMENT
Marcella Brock & Adenike Fajemisin v. Dignity Health, et al..
Superior Court of California, Los Angeles County
Case No. BC616408
TO EXCLUDE YOURSELF FROM THE SETTLEMENT IN THIS CASE, YOU MUST COMPLETE, SIGN AND RETURN THIS FORM BY U.S. MAIL, FAX, OR E-MAIL, OR SUBMIT ONLINE BY MAY 29, 2018
By signing and returning this Request For Exclusion From Class Action Settlement Form, I am certifying that I have carefully read the Notice Of Proposed Class Action Settlement and that I wish to be excluded from the Settlement described therein. I understand that this means I will not be eligible to receive any Settlement Payment and I will not have standing to object to the Settlement or Class Counsel’s Motion for Attorney’s Fees and Costs or Plaintiff’s Service Award. I also understand that, if I am excluded from the Settlement, I may bring a separate lawsuit seeking damages, but that there is no guarantee of the outcome of such case and I might recover nothing or less than what I would have recovered if I had filed a Settlement Claim And Consent To Join Form under this Settlement.
FILING BY MAIL. You may submit a Request for Exclusion by signing, completing, and mailing this Form to the address below. This is not a Claim Form. Do not mail this Exclusion Form if you wish to remain in the settlement class. CLICK HERE TO DOWNLOAD PDF FORM
Trustaff Healthcare Solutions, LLC Claims Administrator
c/o Phoenix Settlement Administrators
P.O. Box 7208
Orange, CA 92863