TO RECEIVE A PAYMENT, YOU MUST COMPLETE AND SUBMIT THIS CLAIM FORM TO THE SETTLEMENT ADMINISTRATOR BY DECEMBER 04, 2019.

Please read this form carefully and follow the instructions below. You may submit the Claim online by completing the required information and clicking "Submit" by DECEMBER 04, 2019. You may also print out and mail the form, available on the Important Documents page.


STEP 1: CLAIMANT INFORMATION


1
1This number is the 9-digit alphanumeric number located in the Notice you received. If you do not provide this number, your claim form may be rejected.


* Required