Exhibit 6

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1377754.1

CLAIM FORM FOR OUT-OF-POCKET COSTS

In re: Yahoo! Inc. Customer Data Security Breach Litigation

USE THIS FORM TO MAKE A CLAIM FOR REIMBURSEMENT OF OUT-OF-POCKET COSTS YOU 

BELIEVE YOU INCURRED AS A RESULT OF THE YAHOO DATA BREACHES

YOU MAY MAKE A CLAIM FOR OUT-OF-POCKET COSTS IN ADDITION TO A CLAIM FOR CREDIT 

MONITORING SERVICES OR ALTERNATIVE CASH COMPENSATION

THE DEADLINE TO SUBMIT THIS CLAIM FORM IS: [270 DAYS FROM PRELIMINARY APPROVAL]

I. GENERAL INSTRUCTIONS

If you had a Yahoo account between January 1, 2012, and December 31, 2016, you are a “Settlement Class Member.” 

Settlement Class Members are entitled to request reimbursement of “Out-of-Pocket Costs” that they believe they incurred

as a result of the Yahoo Data Breaches. If you received an emailed notice from the Settlement Administrator about this 

class action settlement addressed to you, then the Settlement Administrator has already determined that you are a 

Settlement Class Member. To learn more about the Settlement or how to determine whether you are Settlement Class 

Member (if you did not receive emailed notice), go towww.settlementwebsite.com/page.

If you are a Settlement Class Member, and you believe you spent money or lost time or money related to the Data 

Breaches, then you may make a claim for reimbursement. The Settlement consists of a fund of $50 million to pay all 

valid Claims of all Settlement Class Members—including claims for Paid Users and Small Business Users. To the extent 

all Settlement Class Members’ claims under the Settlement Agreement exceed $50 million, then the amount of each claim 

will be reduced proportionally (by a percentage) until the total payments are equal to $50 million. 

Out-of-Pocket Costs incurred from January 1, 2012 to the present which may be eligible for reimbursements include, but 

are not limited to:

 The costs of credit monitoring or identity protection services you obtained (up to the date on which Credit 

Monitoring Services become available through this Settlement).

 Unreimbursed losses, fees, or charges incurred as a result of identity fraud or theft connected with the 

possible misuse of your name, email address, telephone number, birth date, password, and security 

questions at Yahoo, or from contents of your email account, such as financial communications and records 

containing credit cards, retail accounts, banking, account passwords, IRS documents, and social security 

numbers from transactions conducted by email (“Personal Information”).

 Professional fees and other costs incurred addressing identity fraud or theft, including falsified tax returns 

or other identity fraud or theft, connected with the possible misuse of your Personal Information.

 Costs associated with credit freezes.

 Miscellaneous expenses such as notary, fax, postage, copying, mileage, and long-distance charges that you 

show were incurred in connection with identity fraud or theft connected with the possible misuse of your 

Personal Information.

 If you can adequately document identity fraud or theft connected with the possible misuse of your Personal 

Information you may be eligible for reimbursement of up to fifteen hours of time spent remedying issues 

related to one or more of the Data Breaches (calculated at $25 per hour, or time off work at your 

documented hourly wage, whichever is greater), or, if you cannot provide documentation, up to five hours 

of time spent remedying issues related to one or more of the Data Breaches, at $25 per hour, or time off 

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work at your documented hourly wage, whichever is greater.

This list provides examples only, and other costs due to one or more of the Data Breaches may also be eligible for 

reimbursement. However, YOU MUST BE ABLE TO DOCUMENT YOURCLAIM. 

The Settlement Administrator has the sole authority to determine the validity of claims for Out-Of-Pocket Costs. Only 

valid claims will be paid. To the extent only portions of the claim can be adequately documented and validated, only 

those portions will be paid. To the extent the amounts required to fund valid claims exceed the amount of the Settlement 

Fund, the cash payments for the valid claims will be reduced on a pro rata basis. The deadline to file an Out-of-Pocket 

Costs Claim is ____________, 2019.

If you are a Settlement Class Member, you may also submit a claim for two years of Credit Monitoring Services at 

no cost to you, or Alternative Cash Compensation if you already have credit monitoring, by filing a Credit 

Monitoring Services or Alternative Cash Payment Claim Form, available at: www. .com.

In order for your claim to be considered, you must fully complete this Claim Form. You can complete and submit this 

Claim Form online at www.settlementwebsite.com/page. 

Or, type or legibly print all information in blue or black ink, answering all questions below, and submit the completed 

Claim Form, including any documentation that may be required, to the Settlement Administrator by U.S. mail, 

postmarked on or before [date], at the following address:

[ADDRESS]

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II. CLAIMANT INFORMATION

The Settlement Administrator will use this information for all communications regarding this Claim Form and the 

Settlement. If this information changes, you MUST notify the Settlement Administrator in writing at the address above.

Claimant Last Name, First Name, Middle Initial

Other name(s) you use (if any)

Name of Representative (if someone else is filing this claim for the person named in the claim)

Mailing Address – Line 1: Street Address/P.O. Box

Mailing Address – Line 2 (If Applicable): Apartment/Suite/Floor Number

City State Zip Code

Home Phone Number Work Phone Number Cell Phone Number

Current Email Address

Date of Birth (mm/dd/yyyy) Claim Number Provided By Settlement Administrator (if known)

Yahoo accounts you held between January 1, 2012 and December 31, 2016 (attach additional sheets if needed):

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PAYMENT ELECTION

I wish to receive my payment, if approved, by (Select only one):

Check made out to me as an individual at the address above.

Direct Deposit* Email Address: ____________________________________

*If you select Direct Deposit, you will be contacted at the email address provided above prior to the distribution of 

payments to provide your banking information via a secure site to initiate your payment. You must provide your email 

address so the Settlement Administrator can contact you.

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III. DOCUMENTATION OF HARM

Fill out the below to claim costs relating to the Yahoo Data Breaches (attach additional pages as needed):

Cost Type

(Fill all that apply)

Approximate Date of 

Loss Amount of Loss Description of Supporting Documentation

(Identify what you are attaching and why)

 Unreimbursed fraud

losses or charges

/ /

(mm/dd/yy) $ .

Examples: Account statement with 

unauthorized charges highlighted; 

Correspondence from financial institution 

declining to reimburse you for fraudulent 

charges

 Professional fees

incurred in 

connection with 

identity theft or 

falsified tax returns

/ /

(mm/dd/yy) $ .

Examples: Receipt for hiring service to assist 

you in addressing identity theft; Accountant 

bill for re-filing tax return

 Lost interest or other

damages resulting 

from a delayed state 

and/or federal tax 

refund in connection 

with fraudulent tax 

return filing

/ /

(mm/dd/yy) $ .

Examples: Letter from IRS or state about tax 

fraud in your name; Documents reflecting 

length of time you waited to receive your tax 

refund and the amount

 Credit freeze

/ /

(mm/dd/yy) $ .

Examples: Notices or account statements 

reflecting payment for a credit freeze:

 Credit monitoring

that was ordered after 

January 2012 through 

the date on which the 

Credit Monitoring 

Services become 

available through this

Settlement

/ /

(mm/dd/yy) $ .

Example: Receipts or account statements 

reflecting purchases made for credit 

monitoring services

 Miscellaneous 

expenses such as 

notary, fax, postage, 

copying, mileage, and 

long- distance 

telephone charges

/ /

(mm/dd/yy) $ .

Example: Phone bills, gas receipts, postage 

receipts; detailed list of locations to which 

you traveled (i.e. police station, IRS office), 

indication of why you traveled there (i.e. 

police report or letter from IRS re: falsified 

tax return) and number of miles you traveled

 Other (provided 

detailed description)

/ /

(mm/dd/yy) $ .

Please provide detailed description:

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IV. CLAIMS FOR ADDITIONALTIME

If, in addition to the above, you spent time addressing issues related to one or more of the Data Breaches, you may be 

compensated at $25 per hour or unpaid time off work at your actual hourly rate, whichever is greater, for up to 15 hours, 

for documented claims. If you cannot provide documentation, you may be compensated at $25 per hour or unpaid time 

off work at your actual hourly rate, whichever is greater, for up to 5 hours. 

• If you spent time remedying issues relating to one or more of the Yahoo Data Breaches, please indicate the 

number of hours here:

• If you took unpaid time off work, please provide documentation of the number of hours that you took off work, 

and your hourly age.

• Please explain in detail how this time was expended and why it was necessary:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

• Please also provide any available documentation of the potential fraud and/or identity theft that made this 

expenditure of time necessary (i.e. letter from IRS or bank; police report).

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V. CERTIFICATION

I hereby certify under penalty of perjury that I have personal knowledge of all of the information I provided in this 

Claim Form and that such information is true and correct to the best of my knowledge.

Signature of Claimant Date

If the Claimant is not the person completing this form, the following also must be provided:

Signature of Representative Date

Capacity of person signing on behalf of Claimant, if other than an individual, e.g., executor, president, trustee, 

guardian, custodian, etc. (must provide evidence of authority to act on behalf of Claimant).

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