Res-2021-147 - Laserfiche WebLink

Home Browse Search

ln re Mercedes-Benz Emissions Litigation Class Action Settlement Claim Form Claim Form lnstructions NEXT STEPS AFTER COMPLETING SECTION B: lf you are a current owner or lessee of the Subject Vehicle, fill out Section C and Section E below (skip Section D). lf you no longer own or lease the Subject Vehicle and did not install the AEM while you possessed it, skip Section G and fill out Sections D and E below. lf you no longer own or lease the Subject Vehicle, but you installed the AEM while you still possessed the Subject Vehicle, fill out Sections C and E below and skip Section D. lf you began owning or leasing and registered the Subject Vehicle on or before September 14,2020, check here: lf you began owning or leasing and registered the Subject Vehicle after September 14,2020, check here lf the Subject Vehicle was registered in your name at the time the AEM was installed, check here: Please enter the date the AEM was installed in the Subject Vehicle (MM/DD|/YYY): lf the Subject Vehicle was not registered in your name at the time the AEM was installed, you are not eligible for a Current Owner/Lessee Payment or Post-Announcement Owner/Lessee Payment. Tfgnspoftation Costs lf all three of the above apply to you, you may be eligible to receive reimbursement (up to $35) for transportation costs to and from the Authorized Service Provider while you did not have use of your Subject Vehicle. To receive the transportation reimbursement, you must submit with your Claim Form a receipt detailing your transportation costs. lf any of the three above does not apply to you, you are not eligible for reimbursement of transportation costs. lf you are claiming Transportation Reimbursement, check here: lf you have questions about filling out this form, please visit mbbluetecsettlement.com or call'l -877-3 1 3-0 1 70 To view JND's privacy policy, please visit https://www.indla.com/privacv-policv -4- SECTION C: CURRENT OWNERS/LESSEES AND FORMER OWNERS/LESSEES WHO INSTALLED THE AEM lf ryouihave ;already installed the AEM,select each'of the following that applies'to you:(if,,any|: The Authorized Service Provider took longer than 3 hours to install the AEM in my Subject Vehicle No loaner vehicle, shuttle service, or other alternative transportation was made available to me. During the installation process, I did not have use of my Subject Vehicle and I incuned costs for transportation to and from the Authorized Service Provider.