Experian Mediation Program Claim Submission Form

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If you need help with completing this form, please contact class counsel at 804-835-6700 or
 experiansettlement@cla.law.

Personal Information










General Claim Information


Updating claim: Experian failed to update your credit report to reflect the accurate status of your public record after the public record was paid, dismissed, vacated, or misreported. You do not dispute that the public record belongs to you though.

Ownership claim: Experian reported a civil judgment or tax lien on your credit report that did not belong to you.

A civil judgment is a ruling made against someone in a civil court, a non-criminal matter. This typically relates to an outstanding debt to a lender or creditor.

A tax lien is a lien imposed by law upon a property to secure the payment of taxes (income, property, or other). This category includes state and federal tax liens.

If able, please include details about the date that you first noticed this inaccuracy appearing on your credit report and the date you last noticed it appearing on your credit report.

Ex. costs for ordering your credit report, fees paid to the court to obtain your court record, fees paid to an attorney to help you correct your report


Please include all disputes. Include dates of disputes, form of dispute (online, letter, phone), and results of dispute

If you need help with completing this form, please contact class counsel at 804-835-6700 or
 experiansettlement@cla.law.

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If you need help with completing this form, please contact class counsel at 804-835-6700 or
 experiansettlement@cla.law.

Please provide evidence that the civil judgment or tax lien has been paid or satisfied, including the date the record was paid or satisfied (such as a date-stamped court record).

For a civil judgment, this sort of document can be obtained from the court where your judgement was filed. Contact the court, and request a Satisfaction of Judgment or a Release and Satisfaction from the court where your judgment was filed.

A Satisfaction of Judgment, also referred to as a Release and Satisfaction is a legal document filed with the court that indicates the judgment had been paid, dismissed, vacated. You should have been provided a copy of this document when your judgment was satisfied, but if you did not, you can request a copy directly from the court. You will need to contact the court where your judgment was filed. Some courts have online record systems where you can print a copy this document.

For a tax lien, this sort of document can be obtained from the government agency where it was filed – often this agency is the county Register of Deeds, or state Department of Revenue, or the IRS. Contact the agency, and request a Lien Satisfaction.

Once a tax lien is satisfied or released, you should receive a lien notice of satisfaction or a lien notice of release.

Please provide proof that Experian reported a civil judgment or tax lien on your credit report that did not belong to you.

Examples of proof are:
  • your Experian report, showing the civil judgment or tax lien that does not belong to you; 
  • a copy of your dispute with Experian, if you have previously disputed the inaccurate record; 
  • a copy of the actual public record that was reported, which shows it does not belong to you (such as a copy of the court’s record of the civil judgment, or tax lien)
Adverse Action Details
An adverse action can include things like a denial of credit; denial of insurance; denial of employment; denial of housing; higher interest rate; higher insurance rate; lower credit limit; lower loan amount; decrease in credit limit on existing account; or an increase on an existing insurance rate.

If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
This would be the date you were notified of the adverse action. For example, the date you were denied a loan, credit card, apartment, job, or insurance, or the date your credit limit decreased. To receive a settlement offer, your adverse action date must have taken place between January 15, 2014 and September 21, 2018.

If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you

2nd Adverse Action
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you

3rd Adverse Action
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you

4th Adverse Action
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you

5th Adverse Action
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you

6th Adverse Action
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
If you don't remember the day, just enter the 1st day of the month. If you don't remember the year, enter January.
Ex. a notice from the company describing the adverse action and why the company took it against you
If you need help with completing this form, please contact class counsel at 804-835-6700 or
 experiansettlement@cla.law.

You MUST click the submit button on the next page to finalize your response.