Submit a Claim - Page 1

Unique ID:

To continue with your submission, please provide the Unique ID from your Notice.*

Claimant Information:
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Last 4 of Social Security Number:*

Minor/Guardian Status:

Please indicate if the Class Member is currently a minor or an individual with a Guardian:*

  •  Class Member is currently a minor or an individual with a Parent/Guardian
  •  Class Member was not a minor or an individual with a Parent/Guardian during the Class Period
Parent/Guardian Information:
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By checking this box, I certify that I am the legal Parent or Guardian authorized to file this Claim Form on behalf of the Class Member.*
Contact Information:

The Claims Administrator will use this information for all communications regarding this Claim Form and the Settlement. If this information changes prior to the distribution of payments, you must notify the Claims Administrator. If your claim is approved, Settlement benefits will be sent to you using the information you provide here.

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