Submit a Claim - Page 1

Identity of Claim Filer:

Please indicate whether the person filing this Claim Form is a direct or a third party filer:*

Note: If you answer "Direct Filer," you will skip the next page of this Claim Form.

Claimant Information:

The individual/entity provided in this section purchased Instrument Panel Clusters products from one of the named Defendants.

Please select the type of Claimant:*

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Taxpayer Identification Number:* Help
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Social Security Number:* Help
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Please provide a phone number and email address that can be used by the Settlement Administrator for correspondence regarding this Claim.

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If the Claimant on whose behalf this claim is being submitted acquired the rights that are the basis of their claim from some other person or entity (as assignee, transferee, successor or otherwise), please check the box below and upload copies of legal documents at the end of this Claim Form that support the acquisition of your claim.

 This claim is based upon an assignment or transfer and I will be uploading copies of supporting legal documents.

Upload Icon Required: At the end of this Claim Form, you will be required to upload supporting documents that support the acquisition of your claim.

Unique ID:

To aid in the processing of your Claim Form, please provide the Unique ID from the Claim Package you may have received.

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