Election to Opt Back In
THIS FORM CONCERNS THE SPENCER v. THE HARTFORD CLASS ACTION.
IT HAS ALREADY BEEN DETERMINED THAT YOU QUALIFY TO BE A MEMBER OF THE SETTLEMENT CLASS
BECAUSE YOU PREVIOUSLY ENTERED INTO A STRUCTURED SETTLEMENT WITH THE HARTFORD.
HOWEVER, YOU PREVIOUSLY REQUESTED TO EXCLUDE YOURSELF FROM THIS ACTION. HAD YOU NOT
EXCLUDED YOURSELF YOU WOULD BE ENTITLED TO RECEIVE A PAYMENT FROM THE PROPOSED
SETTLEMENT IF THE SETTLEMENT IS APPROVED BY THE COURT.
UNDER THE PROPOSED SETTLEMENT YOU MAY OPT BACK INTO THIS ACTION BY SIGNING THE ELECTION TO
OPT IN BELOW, AND MAILING THIS FORM TO THE ADDRESS PROVIDED POSTMARKED NO LATER THAN
SEPTEMBER 7, 2010. UNLESS YOU RETURN THIS FORM POSTMARKED BY SEPTEMBER 7, 2010, YOU WILL
REMAIN EXCLUDED AND YOU WILL NOT RECEIVE A PAYMENT UNDER THE PROPOSED SETTLEMENT.
A federal court authorized this notice. It is not a solicitation from a lawyer. You are not being sued.
IMPORTANT NOTE: The information provided in this Notice of Settlement Distribution Form is confidential and will be
kept confidential.
IMPORTANT NOTE: Completing and submitting this Claim Form will not have any effect on the terms of your existing
structured settlement with The Hartford or any payments that remain due to you under the terms of your structured
settlement. Your structured settlement will remain in full force and effect, and The Hartford will still be obligated to make
any and all payments due to you, whether now or in the future, under the original terms of your structured settlement.
Your Information
Name: ___________________________________________________________________________________________
First M.I. Last Jr., Sr., III, etc.
Address: ________________________________________________________________________________________
Street or P.O. Box
_________________________________________________________________________________________________
Street or P.O. Box, cont’d
__________________________ ___________ _______ - ________
City State Zip +4
Home Telephone #: _____________________________ Work Telephone #: _________________________________
Information about Your Structured Settlement
Annuity Number(s): Name of Annuitant:
Your Election to Opt Back In
I elect to opt back in to the Spencer v. The Hartford Class Action. Executed on ________________, 2010 (Date)
________________________________________ ________________________________________
Signature Print Name
Please enclose this form in the provided pre-addressed, postage paid envelope and mail it to:
Spencer, et al. v. Hartford Financial Services Group, Inc., et al.
c/o The Garden City Group, Inc.
P.O. Box 9349
Dublin, OH 43017-4249
YOU MUST MAIL THIS FORM POSTMARKED ON OR BEFORE SEPTEMBER 7, 2010.