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Toyota Settlement Registration/Claim Form

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Toyota Settlement Registration/Claim Form SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles A SETTLEMENT FUND HAS BEEN CREATED, AND YOU MAY BE ENTITLED TO A CASH PAYMENT. To Register/Submit a Claim for a Payment from the Settlement Fund (a “Settlement Payment”), YOU MUST: 1. Bring or have brought your vehicle (one of the “Subject Vehicles” listed in Section II, below) to a Toyota, Lexus, or Scion dealership for the Takata Airbag Recall Remedy, as directed by a recall notice; OR 2. Have sold or returned your Subject Vehicle after April 11, 2013 and prior to June 9, 2017, if your Subject Vehicle was recalled prior to June 9, 2017. AND YOU MUST EITHER: 1. Register and submit your claim for reimbursement of the reasonable expenses you incurred related to the Takata Airbag Recall; OR 2. Register to potentially receive up to a maximum of $500 from the Settlement Fund. IMPORTANT NOTE: Some vehicles included in the Settlement will be recalled at a later date and others may not require a recall. Your receipt of a Settlement Notice does not mean your vehicle is subject to a recall. Please refer to Toyota, Lexus, and Scion’s website, www.Toyota.com/Recall, or the National Highway Traffic Safety Administration’s website, www.SaferCar.gov, for the latest information about Takata recalls and to determine if your vehicle is subject to a recall. T 01- CA974 S3481 v.11 08.14.2017 Page 1 of 7 SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles INSTRUCTIONS FOR REGISTERING/SUBMITTING A CLAIM FOR A SETTLEMENT PAYMENT Please Read These Instructions Carefully 1. Subject to certain limited exclusions, you are a person or entity eligible to register/submit a claim for a Settlement Payment if: a. You owned or leased, on June 9, 2017, a Subject Vehicle distributed for sale or lease in the United States or its territories or possessions, AND you bring or have brought your Subject Vehicle to a Toyota, Lexus, or Scion dealership for the Takata Airbag Recall Remedy; or, b. You sold, or returned pursuant to a lease, a Subject Vehicle distributed for sale or lease in the United States or its territories or possessions after April 11, 2013 and before June 9, 2017, if the Subject Vehicle was recalled prior to June 9, 2017. 2. To register/submit a claim for a Settlement Payment, you must either: a. Submit an electronic Registration/Claim Form online by visiting www.AutoAirbagSettlement.com (online registration will result in expedited processing); or, b. Submit a paper Registration/Claim Form by completing this form and returning it along with any required documentation by U.S. Mail or email to: Mailing Address: Auto Airbag Settlement Settlement Notice Administrator P.O. Box 3207 Portland, OR 97208-3207 Email: [email protected] 3. The deadline for submitting a Registration/Claim Form is as follows: a. If you sold or returned, pursuant to a lease, a recalled Subject Vehicle after April 11, 2013 and before June 9, 2017, and your vehicle was recalled under the Takata Airbag Inflator Recall prior to June 9, 2017, you have one year from the date that the Settlement becomes final (the “Effective Date”) to submit a Registration/Claim Form. b. If you owned or leased a Subject Vehicle on June 9, 2017, the deadline for submitting a Registration/Claim Form is one year after the Effective Date, or one year after the date the Recall Remedy is performed on your Subject Vehicle, whichever is later, until the Final Registration/Claim Deadline is reached. IMPORTANT: NO REGISTRATION/CLAIM FORMS MAY BE SUBMITTED AFTER THE FINAL REGISTRATION/CLAIM DEADLINE. THE EFFECTIVE DATE AND THE FINAL REGISTRATION/CLAIM DEADLINE ARE NOT YET KNOWN, BUT WILL BE POSTED PROMINENTLY ON THE SETTLEMENT WEBSITE, WWW.AUTOAIRBAGSETTLEMENT.COM, WHEN THEY ARE KNOWN. 4. If you are or were the registered owner or lessee of more than one Subject Vehicle, you must submit a separate Registration/Claim Form for each Subject Vehicle to obtain a separate out-of-pocket Settlement Payment for each Subject Vehicle you own(ed) or lease(d). However, claims for unreimbursed expenses cannot be duplicative. T 02- CA974 S3482 v.11 08.14.2017 Page 2 of 7 SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles 5. Capitalized terms in this Form have the same meaning as provided in the Settlement Agreement, which is available for download at www.AutoAirbagSettlement.com. The Long Form Notice, which is also available for download at www.AutoAirbagSettlement.com or by calling 1-888-735-5596, also explains key terms of the Settlement, including the definition of Effective Date. 6. Type or print legibly in blue or black ink. Do not use any highlighters. Provide all requested information to complete and submit this Form, attach supporting documentation, as specified below, and sign the Form. IMPORTANT: KEEP A COPY OF YOUR COMPLETED REGISTRATION/CLAIM FORM AND THE SUPPORTING DOCUMENTS. ANY DOCUMENTS YOU SUBMIT WITH YOUR FORM WILL NOT BE RETURNED. IF YOUR CLAIM IS REJECTED FOR ANY REASON, YOU WILL BE NOTIFIED AND GIVEN AN OPPORTUNITY TO ADDRESS ANY DEFICIENCIES. THE SETTLEMENT SPECIAL ADMINISTRATOR’S DECISIONS REGARDING CLAIMS FOR REIMBURSEMENT OF OUT-OF-POCKET EXPENSES SUBMITTED BY CLASS MEMBERS IS FINAL AND CANNOT BE APPEALED. SECTION I: CLASS MEMBER INFORMATION Please fill in the below contact information. This information will only be used to contact you regarding the Auto Airbag Settlement. Business Organization/Trust Name(s) (if applicable): First Name: MI: Last Name: Address 1: Address 2: City: State: ZIP: Country: Phone: – – Email: T 03- CA974 S3483 v.11 08.14.2017 Page 3 of 7 SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles SECTION II: VEHICLE INFORMATION Please enter the Vehicle Identification Number (VIN) of your Subject Vehicle. The VIN can be found on the dashboard of the vehicle, the vehicle’s registration, or the vehicle’s title, and is 17 characters long. To confirm whether or not your vehicle is eligible for participation in the Auto Airbag Settlement, please visit www.AutoAirbagSettlement.com. Vehicle Identification Number (VIN): TOYOTA SETTLEMENT SUBJECT VEHICLES Check the box next to your vehicle model and model year. Check only one. Toyota Corolla Toyota Matrix 2003 2004 2005 2006 2003 2004 2005 2006 2007 2008 2009 2010 2007 2008 2009 2010 2011 2012 2013 2014 2011 2012 2013 2015 2016 2017 Toyota R AV4 Toyota Sequoia 2004 2005 2002 2003 2004 2005 2006 2007 Toyota Sienna Toyota Tundra 2011 2012 2013 2014 2003 2004 2005 2006 Toyota Yaris Toyota 4Runner 2006 2007 2008 2009 2010 2011 2012 2013 2010 2011 2012 2014 2015 2016 2017 Toyota iM Lexus ES350 2017 2007 2008 2009 2010 2011 2012 Lexus GX460 Lexus IS 2010 2011 2012 2013 2006 2007 2008 2009 2014 2015 2016 2017 2010 2011 2012 2013 Lexus IS-F Lexus IS250/350 2008 2009 2010 2011 2014 2015 2012 2013 2014 Lexus IS250C/350C Lexus IS350/300/200T 2010 2011 2012 2013 2016 2017 2014 2015 T 04-CA974 S3484 v.11 08.14.2017 Page 4 of 7 SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles Lexus RC-F Lexus LF-A 2015 2016 2017 2012 Lexus 350/300/200T Lexus SC430 2015 2016 2017 2002 2003 2004 2005 2006 2007 2008 2009 2010 Scion iM Scion XB 2016 2008 2009 2010 2011 2012 2013 2014 2015 Yes 1. Did you purchase or lease your Subject Vehicle before June 9, 2017? No Yes 2. Did you still own or lease your Subject Vehicle on June 9, 2017? No 3. Did you bring your Subject Vehicle to a Toyota, Lexus, or Scion dealership for the Takata Airbag Yes Recall Remedy? No 4. If you answered “No” to Question 2 in this Section, did you sell, or return pursuant to a lease, your Yes Subject Vehicle after April 11, 2013 and before June 9, 2017? No SECTION III: OUT-OF-POCKET EXPENSES 1. Did you pay for any expenses, as further defined below, related to the Takata Airbag Inflator Recall Yes for your Subject Vehicle that have not been reimbursed by Toyota? No If you answered “Yes” to Question 1 in this Section, please complete the remainder of this Section and Section IV to submit a claim for reimbursement of the out-of-pocket expenses you incurred, in addition to a potential later payment of up to $250 from the Settlement Fund. If you answered “No” to Question 1 in this Section, please skip to and complete Section IV below to register for total potential payments of up to $500 from the Settlement Fund. T 05 - CA974 S3485 v.11 08.14.2017 Page 5 of 7 SETTLEMENT REGISTRATION/CLAIM FORM Auto Airbag Settlement for Certain Toyota, Lexus, and Scion Vehicles The Settlement Special Administrator will process and approve payments from the Settlement Fund in accordance with the terms of the Settlement Agreement. Payments for reimbursable out-of-pocket expenses will be made first, and if sufficient funds remain in the Settlement Fund at the end of each program year, that money will be paid to Class Members who: (a) submitted claims for out-of-pocket expenses in that year or prior program years that were previously rejected; or (b) sought to register for a Residual Distribution payment only. Reimbursements for out-of-pocket expenses will be made on a first-in-first-out basis during years one through three, until the Settlement Fund is depleted for that year.
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