Res-2021-147 - Laserfiche WebLink

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tshtEffi:In re Mercedes-Benz Emissfons Litigation Class Action Settlement Claim Form Claim Form lnstructions You must complete, sign, and return the enclosed Claim Form to receive a payment under the Class Action Settlements.l Please read the full Long Form Notice, which is available at the Settlement Website, mbbluetecsettlement.com. before completing your Claim Form. lf you have questions about this Claim Form, please visit the Settlement Website, call {-877-313-0170 toll-free or email info@mbbluetecsettlement.com. 'qtAtM gu BlllltssroN rt NsTRUcTto NS'AN D DEADLTN ES : "'l ,' : i. GBD DV3GSYBTMD a a a To receive a Class Member Payment, you must submit a completed and signed Claim Form, including all required documentation, by the deadline that applies to you. These deadlines are set forth in detail at the Settlement Website, mbbluetecsettlement.com. To summarize: o lf you are an Eligible Current Owner/Lessee, your claim must be submitted online or postmarked by October 1,2022. o lf you are an Eligible Former Owner/Lessee, your claim must be submitted online or postmarked by July 12, 2021, or by the date the Court finally approves the Mercedes Class Action Settlement (if after July 12,20211. Please visit mbbluetecsettlement.com for updates about the deadline to submit your claim. o You may submit your completed Claim Form and all required documents online at mbbluetg.qs.ettlement.com. You may also mail your completed Claim Form and documentation to: MB BlueTec Settlement c/o JND Legal Administration PO Box 91310 Seattle, WA 98111 You should not wait until close to the deadline to submit your Claim Form. All Claim Forms require information and documentation that you might need time to collect, and all Eligible Current Owners/Lessees must have scheduled and completed installation of the AEM for their vehicle before submitting their Claim Form. The following documentation is required to submit a claim: o A completed and signed Claim Form o Proof of current or former ownership or lease, including dates of ownership or lease, for your Subject Vehicle o Proof of vehicle registration for your Subject Vehicle o Fully executed lndividual Release (a copy of the lndividual Release is included with this Claim Form) The "Class Action Settlements" are the separate class settlements with the Mercedes Defendants (the "Mercedes Class Action Settlement") and with the Bosch Defendants (the "Bosch Class Action Settlement"), which can be found at mbbluetecsettlement.com. All capitalized terms in this Claim Form are defined in the Mercedes Class Action Settlement. lf you have questions about filling out this form, please visit mbbluetecsettlement. com or call 1 -87 7 -3'l 3-017 0 To view JND's privacy policy, please visit httos://www.indla.com/privacli-policy lnstructions for Completing the Enclosed Claim Form