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InreMercedes-BenzEmissionsLitigationClassActionSettlementClaimFormClaimFormInstructionsoIfyouareanEligibleCurrentOwner/Lessee,arepairordershowingtheApprovedEmissionModification("AEM")isinstalledinyourSubjectVehicle•IfyouareanEligibleCurrentOwner/Lessee,youmustscheduleanappointmentandhavetheAEMinstalledbeforesubmittingyourClaimFormandrequireddocuments.YouwillbeeligibleforaClassMemberPayment_onlyaftertheAEMisinstalled(atnochargetoyou).YoucancheckwhethertheAEMisavailable_nowforyourSubjectVehiclebyvisitingtheSettlementWebsite,mbbluetecsettlement.com,whereyoucantypeinyourVehicleIdentificationNumber("VIN")tochecktheAEMavailabilityforyourvehicle,orreviewalistingofallSubjectVehiclemodelsthatarereadyfortheAEMinstallation.Ifyourvehicleisnotlisted,youwillbenotifiedwhentheAEMbecomesavailable.PleasecontinuetochecktheSettlementWebsiteforupdatedinformation.Youmayalsocall1-877-313-0170toll-freetofindoutwhetheranAEMisavailableforyourSubjectVehicle.Youcanfindalistofthetypesofdocumentsthatfulfillthedocumentationrequirementsbelow.CLAIMREVIEWANDPAYMENTPROCESS:•AfteryouhavesubmittedyourClaimForm,theSettlementAdministratorwillreviewyourClaimFormandsupportingdocumentsforcompletenessandeligibility.TheSettlementAdministratorwillalsoscreentheclaimsforfraudanddeterminethepaymentamount.•IftheClaimFormorrequireddocumentationisincomplete,illegible,orotherwisedeficient,theSettlementAdministratorwillnotifyyouthatthereisadeficiencyorthatmoreinformationisneeded.Ifyoudonottimelycomplyand/orareunabletoproducetherequestedinformation,yourclaimwillbedeniedandyouwillnotreceiveaClassMemberPayment.•ThepaymentamountyoumayreceivedependsonwhenyoupurchasedorleasedtheSubjectVehicle,whetheryouownedorleasedtheSubjectVehicleatthetimetheAEMwasinstalledintheSubjectVehicle,thenumberofclaimsmadeperSubjectVehicleand,forEligibleCurrentOwners/Lessees,whetheryourSubjectVehiclequalifiesforpossibleadditionalpayments.TheSettlementAdministratorwillissuethepaymentafteryourclaimisdeemedcompleteandyouaredeterminedtobeeligibleforaClassMemberPayment.Ifyouhavequestionsaboutfillingoutthisform,pleasevisitmbbluetecsettlement.comorcall1-877-313-0170ToviewJND'sprivacypolicy,pleasevisithttps://www.indla.com/privacy-policy-2-