SEVERE EMOTIONAL DISTRESS FUND CLAIM FORM

Please review the following instructions before proceeding.

In addition to compensation for the Wells Fargo mortgage modification error that all Class Members will receive, you are eligible to apply for additional compensation if you believe you suffered severe emotional distress as a direct result of the error. Cathy Yanni, the court-appointed Special Master, will decide the amount of any compensation to which you may be entitled from the Severe Emotional Distress Fund.

An amount of $1,000,000 of the settlement has been set aside to establish a Severe Emotional Distress Fund. To submit a claim to the Severe Emotional Distress Fund, you must complete this form. You may, but are not required to, submit any documents, including medical records and billing records, that you would like the Special Master to consider.

Please note, if you are a Class Member, you will receive the guaranteed minimum payment described in the Notice you received regardless of whether you submit an additional claim to the Severe Emotional Distress Fund. Please review this Settlement Website for more information.

YOU MUST COMPLETE THE ONLINE CLAIM FORM OR MAIL THE FORM POSTMARKED NO LATER THAN JULY 02, 2020.