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InreMercedes-BenzEmissionsLitigationClassActionSettlementClaimFormClaimFormInstructionsSECTIONA:NAMEANDCONTACTINFORMATION--ALLCLAIMANTSMUSTCOMPLETEPleaseprovideyournameandcontactinformationbelow.YoumustnotifytheSettlementAdministratorifyourcontactinformationchangesafteryousubmityourClaimForm;otherwiseyoumaynotreceiveyourClassMemberPayment.FirstNameMiddleInitialLastNameSuffixJamesNaleMailingAddressPOBox1494CityStateZipCodeEllensburgWA98926-1907EmailAddressBestTelephoneNumbertoContactYouSECTIONB:VEHICLEINFORMATION--ALLCLAIMANTSMUSTCOMPLETEAllclaimantsmustcompletethisSectionB.IfyouaremakingaclaimasanEligibleFormerOwnerorLessee,youmustprovidetheinformationfortheSubjectVehiclethatyouformerlyownedorleased.PleaseprovidethemodelandmodelyearofyourSubjectVehicleintheboxbelow.Besuretowriteclearandneatly.IfyouhaveaclaimformorethanoneSubjectVehicle,youmustsubmitaseparateClaimFormforeachSubjectVehicle.ModelModelYearPleaseentertheVINoftheSubjectVehicleyouenteredabove.TheVINmaybelocatedonyourvehicleregistration,yourcartitleorinvehiclemaintenancerecordsfromyourdealer.YourMercedes-BenzOwner'sManualcanalsodirectyoutothephysicallocationoftheVINonyourvehicle.Toavoidconfusionbetweenlettersandnumbers,pleaseenternumbersinthesameformasthechartbelow.Besuretowriteclearandneatly.ZeroOneTwoThreeFourFiveSixSevenEightNineØ123456789WDYFE8CDOGP308414Enterthe17-digitVINintheboxesabove.Ifyouhavequestionsaboutfillingoutthisform,pleasevisitmbbluetecsettlement.comorcall1-877-313-0170ToviewJND'sprivacypolicy,pleasevisithttps://www.¡ndia.com/privacy-policy-3-