NameThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formhidden last name*This field is hidden when viewing the formname infoThis field is hidden when viewing the formhidden claimant id*This field is hidden when viewing the formhas_name_exceptionOAG Alba Services, Inc. Settlement You may qualify for a payment from the settlement between the Office of the New York State Attorney General (OAG) and Alba because you: • You were injured on the job during the period 2016-2024 and reported your injury to Alba OR • You were sexually harassed on the job during the period 2016-2025. To receive your payment, complete and submit this claim form by July 31, 2026. Phone:*Email:* Claim Form ID:*NAME:* First Name Last Name Change of Address? Please provide your new address:MAILING ADDRESS (include apartment, unit, suite, or post office box as applicable)* Current Street Address: City: State: Zip: Check only one option to receive your settlement payment: NAME:* First Name Last Name This field is hidden when viewing the formCheck if address is non-US Please check if this is a non-U.S. address If your claim is approved you'll get an email to make a payment selection.Payment Method:*This field is hidden when viewing the formPayment Tokendeclare that the above information is true and correct.* By submitting this claim form, I declare that the above information is true and correct. By signing this Claim Form, I declare that the above information is true and correct. Date:* MM slash DD slash YYYY Unique IDClaimFormNo
