EXCLUSION REQUEST FORM

If you do not wish to be part of this lawsuit, you may exclude yourself from all or part of the class action. If you do so, and money or benefits are later awarded for the part of the lawsuit you excluded yourself from, you won’t share in those. But, you keep any rights to sue your visa sponsor separately about the same legal claims in this lawsuit. For more information about excluding or opting out of the lawsuit, please refer to Section No. 15 of the Class Notice.

Exclusion Request Forms can be submitted online by clicking on the button below and completing the online Exclusion Request Form. You can also download an Exclusion Request Form and send the completed form to the class administrator either by email as a PDF attachment to info@aupairclassaction.com or by mail to:

Beltran v. InterExchange
c/o JND Legal Administration
P.O. Box 91345
Seattle, WA 98111.

YOUR EXCLUSION REQUEST FORM MUST BE SUBMITTED OR POSTMARKED BY OCTOBER 3, 2018.

To view the Class Notice, click here.

To view the Notice Appendix, click here.

1. CONTACT INFORMATION

If your name has changed since you began working as an au pair, please also provide your former name(s):

ALTERNATIVE NAME(S):

2. VISA SPONSOR

Select your sponsor(s) from the list below (check all that apply):

3. CLASSES

If you would only like to be excluded from some of the classes, please check the applicable boxes below.

When you click the button below, you will be taken to the DocuSign signature page.
You must provide a digital signature to complete your Exclusion Request form.