To assist you in completing your Confidential Questionnaire and Release claim form, please note the following answers to some FAQs:

• The deadline to submit your Confidential Questionnaire and Release is 11:59 PM EDT on June 12, 2026.
• Only the claimant, not counsel, may submit the Confidential Questionnaire and Release because the form is submitted under penalty of perjury.
• You do not need to complete your Confidential Questionnaire and Release in one session. The Confidential Questionnaire and Release may be downloaded from the Important Documents page in PDF format and you may work on the Confidential Questionnaire and Release at your own pace and once completed, you may upload the Confidential Questionnaire and Release and any supporting documentation.
• Please enter your personal information and not that of your counsel, if any.
• It may be helpful to download and/or print the complete blank Confidential Questionnaire and Release before you start filling it out so you can have a point of reference for how the form is organized in its entirety.
• The Fund Administrator is required to initiate certain searches related to potential medical liens held by Medicare, Medicaid, TRICARE, and the U.S. Department of Veteran Affairs. You will be asked to add your date of injury/illness and social security number and sign various documents to facilitate this process as part of the submission of your Confidential Questionnaire and Release. This is a mandatory part of the claim process.
• You will need to affix your digital signature in three places – at the end of the Confidential Questionnaire and Release (page 29), at the end of the Proof of Representation (page 31), and at the end of the Consent and Authorization for Use and Release of Information (page 32). These fields are in yellow to highlight them for you. Please type your signature in each place. In addition, you must specify the approximate month and year of injury/illness on the Proof of Representation form and the Consent and Authorization for Use and Release of Information. Please enter a date that approximates the date of the sexual misconduct and abuse and express the date as a month and year or month day and year.
• A successful submission of your Confidential Questionnaire and Release will generate a reference number. This reference number is unique to you and will be your login number if you want to add additional information or documentation to your claim file. The Fund Administrator, or JND Legal Administration, will contact you, or your counsel, via email to confirm receipt of your Confidential Questionnaire and Release, or to notify you if there are any deficiencies in your submission that require correction, within 15 days of receipt.
• You will be prompted to upload documents, if any, after you have uploaded the Confidential Questionnaire and Release. Please note the maximum size for upload is 50 megabytes per file, and larger documents must be broken down into smaller files before uploading. Supported file types are .xls, .xlsx, .doc, .docx, .ppt, .pptx, and .jpg.
• If you need to amend your claim after it has been submitted or upload additional documentation, you may do so up until 11:59PM EDT on June 12, 2026. This feature is available on the Upload Supporting Documentation page. You will be prompted for your reference number to continue. A successful upload generates a confirmation reference number. There is no limit to the number of times you may amend or supplement your claim before the deadline.
• If you have additional technical questions, please contact the Fund Administrator, Simone Lelchuk at Claims@2026SurvivorsBankSettlendFund.com.
• The Confidential Questionnaire and Release has been formatted to provide you with the maximum amount of space to enter your response to each question using the online portal. A more compact version of the Confidential Questionnaire and Release is available to review on the Submit Confidential Questionnaire and Release page.