Online Claim Form

I. CLASS MEMBER INFORMATION

The Settlement Administrator will use this information for communications and payments. If this information changes before settlement payments are issued, contact the Settlement Administrator at the address below.

Please provide your tax name and corresponding tax identification number (SSN or EIN). This information will be used only in relation to the payment and reporting of settlement benefits issued as part of these settlements. If you do not provide this information, it will not prevent you from receiving a settlement benefit. However, if you do not provide this information, your payment may be subject to backup withholding at the current rate of 24%.