Additional Settlement Distribution for Victims of Cryptsy

If you received a personalized notice in the mail or via email with a Notice ID/Claim Number and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID/Claim Number exactly as it appears on your personalized Notice, (i.e. 12345678).

OR

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

Please note that this claims portal is scheduled to close on Pacific Time.

Please click the link for GENERAL INSTRUCTIONS

I. WHETHER AND HOW TO SUBMIT A CLAIM – READ PARAGRAPHS 1 – 3 TO DETERMINE WHICH PARAGRAPH APPLIES TO YOU:

IF YOU DID NOT MAKE A CLAIM IN EITHER THE CRYPTSY SETTLEMENT FROM THE CLASS ACTION STYLED Leidel, et al. v. Project Investors, Inc. d/b/a CRYPTSY, Paul Vernon, and Lorie Ann Nettles, U.S. District Court - Southern District of Florida, Case No. 9:16-cv-80060-MARRA (the “Cryptsy Case”) OR IN THE CLASS ACTION STYLED Leidel v. Coinbase, Inc., U.S. District Court - Southern District of Florida, Case No. 9:16-cv-81992-MARRA (the “Coinbase Case”)

1. To recover as a Member of the Class based on your claims in this action, which is the Cryptsy Case, you must complete and, on page hereof, sign this Proof of Claim form, and include the required supporting documents. If you fail to submit a timely and properly addressed (as set forth in paragraph 5 below) Proof of Claim form, your claim may be rejected; and you may not receive any recovery from the Net Additional Recovery obtained in the Cryptsy Case through the action styled James D. Sallah, Esq., not individually, but solely in his capacity as the Court-appointed Receiver for Project Investors, Inc., d/b/a Cryptsy. v. Xiuxia Liu, U.S. Dist. Ct. - S.D. Fla. -- Case No. 9:20-cv-81041-MARRA (the “Liu Action”). Submission of this Proof of Claim form, however, does not assure that you will share in the proceeds of the Net Additional Recovery. Your claim will be reviewed to determine if it satisfies the requirements for distribution of the additional recovery.

IF YOUR CLAIM IN THE CRYPTSY AND/OR COINBASE CASE WAS REJECTED

2. To recover as a Member of the Class based on your claims in this action, which is the Cryptsy Action, you must complete and, on page hereof, sign this Proof of Claim, and include all supporting documents that you did not submit in the Cryptsy and/or Coinbase Case. If you do not submit any additional, new supporting documents, your claim for recovery arising out of the Liu Action will be rejected. If you fail to submit a timely and properly addressed (as set forth in paragraph 5 below) Proof of Claim form, your claim may be rejected and you may not receive any recovery from the Net Settlement Fund created in connection with the additional recovery obtained in the Liu Action. Submission of this Proof of Claim form, however, does not assure that you will share in the proceeds of the Net Additional Recovery. Your claim will be reviewed to determine if it satisfies the requirements for distribution of the additional recovery.

IF YOUR CLAIM IN THE CRYPTSY AND/OR COINBASE CASE WAS APPROVED AND PAID

3. To recover as a Member of the Class based on your claims in the Cryptsy Case, you need not take any action. You do not have to submit a Claim Form in order to receive a payment in this additional recovery obtained in the Liu Action. The approved claim that you submitted in the Cryptsy and/or Coinbase Case will be deemed approved in this case, and you will receive a distribution payment here. If you have since discovered proof of additional holdings at Cryptsy for which you have not yet made a claim, you can make an additional claim here.

5. IF: (A) YOU DID NOT MAKE A CLAIM IN THE CRYPTSY AND/OR COINBASE CASE, (B) IF YOUR CLAIM IN SUCH CASES WAS REJECTED, OR (C) YOU SUBMITTED A CLAIM IN THE CRYPTSY AND/OR COINBASE CASE THAT WAS PAID AND YOU HAVE SINCE DISCOVERED PROOF OF ADDITIONAL CRYPTSY HOLDINGS FOR WHICH YOU HAVE NOT YET MADE A CLAIM, YOU MUST MAIL OR SUBMIT ONLINE YOUR COMPLETED AND SIGNED PROOF OF CLAIM FORM, ACCOMPANIED BY COPIES OF THE DOCUMENTS REQUESTED HEREIN, NO LATER THAN January 12, 2022, ADDRESSED AS FOLLOWS:

Cryptsy Claims Administrator
1650 Arch Street, Suite 2210
Philadelphia, PA 19103

If you are NOT a Member of the Class (as defined in the Notice of Additional Recovery and Corresponding Settlement Agreement from the Cryptsy Case), or if you submitted an approved and paid claim in the Cryptsy and/or Coinbase Case, DO NOT submit a Proof of Claim and Release form unless you have since discovered proof of additional holdings at Cryptsy for which you have not yet made a claim.

II. CLAIMANT IDENTIFICATION

You may submit a Claim if you are a member of the Class. You are a member of the Class if at any time between November 1, 2015 and the present, you were a Cryptsy account holder and held at Cryptsy bitcoin, alternative cryptocurrencies, or any other form of monies or currency that you are unable to access, trade or otherwise obtain. (You are not a Class Member, and cannot make a claim, if you are or were an employee of Cryptsy or of Coinbase, including their shareholders, officers and directors and members of their immediate families, or if you opened an account at Cryptsy after the date that Coinbase closed the Coinbase accounts of Cryptsy and Paul Vernon, which was October 4, 2015.)

Use Part A of this form entitled “Claimant Identification” to identify yourself.

You must sign this claim. Executors, administrators, guardians, conservators, and trustees must complete and sign this claim on behalf of persons represented by them, their authority must accompany this claim, and their titles or capacities must be stated. Failure to provide the foregoing information could delay verification of your claim or result in rejection of the claim.

III. CLAIM FORM

Use Part B of this form entitled “Schedule of Holdings” to supply all required details of your holdings at Cryptsy between November 1, 2015 and the present. If you need more space or additional schedules, attach separate sheets giving all of the required information in substantially the same form. Sign and print or type your name on each additional sheet.

On the schedules, provide all of the requested information with respect to all of your holdings. You must also provide proof of your holdings, such as an account statement, screen shots, trade verifications or other documents that establish that you held such cryptocurrency at Cryptsy between November 1, 2015 and the present. Failure to report all such transactions may result in the rejection of your claim.

NOTICE REGARDING ELECTRONIC FILES: Certain claimants with large numbers of transactions may request, or may be requested, to submit information regarding their transactions in electronic files. All claimants MUST submit a manually signed paper Proof of Claim form whether or not they also submit electronic copies. If you wish to file your claim electronically, you must contact the Claims Administrator at 1-888-868-4936 to obtain the required file layout. No electronic files will be considered to have been properly submitted unless the Claims Administrator issues to the claimant a written acknowledgment of receipt and acceptance of electronically submitted data.

SECTION A: NAME AND CONTACT INFORMATION
* Required Fields
SECTION B: SCHEDULE OF HOLDINGS AT CRYPTSY
TYPE OF CRYPTOCURRENCY DATE PURCHASED QUANTITY PURCHASED QUANTITY HELD BETWEEN 11/1/2015 AND THE PRESENT DATE

Please identify any redemptions, returns, transfers or any other return or recovery of money or cryptocurrencies that you have already received associated with your holdings at Cryptsy held between November 1, 2015 and the present. Such would include, but not be limited to, recoveries from claims and/or lawsuits that you threatened or filed, or any other source. For each return/recovery of money or cryptocurrencies, provide the date you received same, from whom you received same, and the amount of money or cryptocurrencies recovered/returned.

Date Amount From Whom Did You Receive
SECTION C: SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    SECTION D: SUBMISSION TO JURISDICTION OF COURT AND ACKNOWLEDGMENTS

    I (We) submit this Proof of Claim and Release under the terms of the Settlement Agreement described in the Notice. I (We) also submit to the jurisdiction of the United States District Court for the Southern District of Florida, with respect to my (our) claim as a Class Member. I (We) agree to furnish additional information to the Claims Administrator to support this claim if requested to do so. I (We) have not submitted any other claim covering the same Cryptsy holdings and know of no other person having done so on my (our) behalf.

    I/We hereby warrant and represent that I (we) have included the information requested about all of Cryptsy holdings which are the subject of this claim.

    I declare under penalty of perjury under the laws of the United States of America that all of the foregoing information supplied on this Proof of Claim form by the undersigned is true and correct.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: info@cryptsysettlement.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    Full Name
    Email Address
    Phone Number
    Street Address
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@cryptsysettlement.com

    Click here to edit your Claim.