Wai Man Tom et al. v. Hospitality Ventures, LLC d/b/a Umstead Hotel and Spa; NC Culinary Ventures, LLC d/b/a AN Asian Cuisine; and SAS Institute, Inc

Case No. 5:17-CV-00098-FL

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF NORTH CAROLINA WESTERN DIVISION

Please review the Notice you received by postal mail or email for your Notice ID and Confirmation Code, which are the codes that appear in the upper left corner of the Consent Form you received by mail or in the email Notice you may have received by email.

Please remember to enter the full Notice ID exactly as it appears on your personalized notice, including any letters.

If you can’t locate your Notice ID and Confirmation Code, please email the Lawsuit Administrator at info@AnAsianRestaurantCary-ClassActionLawsuit.com for verification, or alternatively you can download the Consent Form from the Important Documents page of this website and mail it to: THE LAW OFFICES OF GILDA A. HERNANDEZ, PLLC 1020 Southhill Dr., Ste 130 Cary, NC 27513.


This is a Claim Form. It INCLUDES you in the Federal (FLSA) claims in this case, as described in the Notice.
ONLY use this Form if you wish JOIN the Federal claims in this case.

I consent to become a party Plaintiff in an action against Defendants under the Fair Labor Standards Act. By joining this lawsuit, I designate the Plaintiff named in the Complaint, Wai Man Tom, as my representative, to the fullest extent possible under applicable laws, to make decisions on my behalf concerning the litigation, the method and manner of conducting and resolving the litigation, and all other matters pertaining to this lawsuit. I choose to be represented by class counsel, The Law Offices of Gilda A. Hernandez, PLLC.

This form must be submitted on or before November 2, 2021.

THE LAW OFFICES OF
GILDA A. HERNANDEZ, PLLC
1020 Southhill Dr., Ste 130
Cary, NC 27513
Tel: (919) 741-8693
Fax: (919) 869-1853
www.gildahernandezlaw.com rkreuz@gildahernandezlaw.com

PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION:
This information will not be made part of any public record and is necessary for your attorney’s files for litigation and possible settlement purposes.

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Please print this page for your records.

Your Consent 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
First Name
Last Name
Street Address
City
State
Zip Code
Email Address
Cell Phone
Home Phone
Position(s) occupied while employed at ÃN Asian Cuisine:
Signature
Date

If you have any questions regarding your Consent, please provide the Submitted Notice ID listed above and email us at info@AnAsianRestaurantCary-ClassActionLawsuit.com

Click here to edit your Consent.