 Enrollment Form for Use After Second Amendment (Word) 52KB
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Claimant Spreadsheet (The Claims Administrator will send this back to you after you submit your Registration Materials.) |
Release of All Claims (The Claims Administrator will make these available to you individualized for each of your Claimants on a secure website after you submit your Registration Materials.) |
Stipulation of Dismissal with Prejudice (Word) 29KB Click here |
Medical Record Authorization Form (The Claims Administrator will make these available to you individualized for each of your Claimants on a secure website after you submit your Registration Materials.) |
Employment Record Authorization Form (The Claims Administrator will make these available to you individualized for each of your Claimants on a secure website after you submit your Registration Materials. This Form is required only if a Claimant is seeking lost wages as provided in Section 4.2 of the Settlement Agreement.) |
Certification of Final Enrollment (Word) 38KB Click here |
Certification of Final Enrollment - Attachment A (Word) 40KB |
