Please Remember to Provide your Signature Under Penalty of Perjury of this Claim Form

If you have one, you must provide a current, valid email address or mobile phone number with your claim submission. If the email address or mobile phone number you include with your submission becomes invalid for any reason, it is your responsibility to provide accurate contact information to the Claims Administrator to receive a payment. When you receive the email and/or mobile phone text notifying you of your Settlement payment, you will be provided with a number of digital payment options to immediately receive your Settlement payment. You will also at that time have the option to request a paper check, but a paper check will take additional time to process. By submitting this claim I expressly consent to the receipt of future communications via email and/or text from the Claims Administrator.

Purchase or Lease Information

Must click Add Vehicle Info to submit your transactions.

Year Make Model Purchase or Lease Date Name Of Dealer State Of Dealer Action

Claimant Signature and Certification

By signing this claim submission, I certify, that the information included with this claim submission is accurate and complete to the best of my knowledge, information, and belief. If I am submitting this claim submission on behalf of a claimant, I certify that I am authorized to submit this claim submission on the claimant’s behalf. I am, or the claimant on whose behalf I am submitting this claim submission is, a member of the Class, and not subject to any of the exceptions to being included in the Class. I agree and consent to be communicated with electronically via email and/or mobile phone text (message & data rates may apply). I agree to furnish additional information regarding this claim submission if so requested to do so by the Claims Administrator.