This claim form must be submitted online or postmarked by October 7, 2021 and must be fully completed, be signed, and meet all conditions of the Settlement Agreement.
Before you complete and submit this Claim Form, you should read and be familiar with the information contained in the notice and FAQs. The Settlement Administrator will review your Claim Form; you may be required to submit additional documentation to validate your claim. If accepted, you will be mailed a check for $950 or, if certain conditions are met, a pro rata share of the Net Settlement Fund, which may be less than $950. This process takes time. Please be patient.
Instructions: Fill out each section of this form and sign where indicated.