HP CLASS ACTION SETTLEMENT CLAIM FORM

Transcription

1 INSTRUCTIONS: HP CLASS ACTION SETTLEMENT CLAIM FORM THE DEADLINE FOR FILING A CLAIM FORM IS: April 8, YOU MAY FILE ONLY ONE CLAIM AND RECEIVE ONLY ONE SETTLEMENT REMEDY FOR EACH HP PRINTER UNIT (HP LASERJET 5L, 6L, 1100, 3100, 3150). 2. IF YOU HAVE MORE THAN ONE PRINTER FOR WHICH YOU ARE SUBMITTING A CLAIM, YOU MAY LIST THE REQUESTED INFORMATION FOR EACH ADDITIONAL PRINTER ON A SEPARATE SHEET OF PAPER, BUT YOU MUST ALSO INDICATE WHICH PRINTERS FALL INTO WHICH SUBCLASS, AND IDENTIFY THE REMEDY YOU ARE SEEKING FOR EACH ADDITIONAL PRINTER. YOU MAY REQUEST ADDITIONAL CLAIM FORMS FROM THE CLAIMS ADMINISTRATION AT HP CLAIMS CENTER, PO BOX 8016, YOUNG AMERICA, MN , YOU MAY ALSO DOWNLOAD ADDITIONAL FORMS AT FOR ADDITIONAL INSTRUCTIONS, SEE SECTIONS BELOW. 3. YOU MUST ANSWER EACH OF THE QUESTIONS IN STEPS #1-4 AND PROVIDE THE NECESSARY DOCUMENTATION REQUIRED FOR YOUR SETTLEMENT SUB-CLASS. (FAILURE TO COMPLETE THE RELEVANT SECTIONS AND PROVIDE THE REQUESTED DOCUMENTATION MAY RESULT IN THE DENIAL OF YOUR CLAIM OR MAY LIMIT THE TYPE OF REMEDY YOU RECEIVE.) 4. THERE ARE 4 SUBCLASSES: A, B1, B2, AND C. THE SETTLEMENT SUBCLASSES ARE DEFINED AS FOLLOWS: SUBCLASS A Current or former owners who repaired HP Printers as defined with Proof of Purchase and proof of repair(s) of the multifeed problem. SUBCLASS B Current or former owners of HP printers as defined with proof of purchase who experienced the multifeed problem and who did not repair or who have no proof of repair. (Note that B1 is 5L owners and B2 is 6L, 1100, 3100 and 3150 owners). SUBCLASS C Current owners of the HP printer with proof of purchase who have not experienced the multifeed problem. 5. AT STEP #4, YOU MUST INDICATE TO WHICH SUBCLASS YOU BELONG. EACH SUBCLASS IS ENTITLED TO A DIFFERENT REMEDY. IF YOU HAVE MULTIPLE UNITS, YOU MAY BE IN A DIFFERENT SUBCLASS FOR DIFFERENT PRINTERS. IF YOU ARE IN DIFFERENT SUBCLASSES FOR DIFFERENT PRINTERS, YOU MUST DESIGNATE WHICH PRINTERS FALL INTO EACH OF THE SUBCLASSES TO WHICH YOU BELONG. 6. ELIGIBLE CLASS MEMBERS IN SUBCLASSES A, B1, AND B2 ARE ENTITLED TO EITHER A PRINTER REBATE CERTIFICATE OR A MEDIA REBATE CERTIFICATE PER PRINTER UNIT. (SUBCLASS B2 IS ALSO ENTITLED TO A REPAIR KIT; SUBCLASS C IS ENTITLED TO A REPAIR KIT ONLY). FOR EACH CLAIM, YOU MAY REQUEST EITHER A REBATE COUPON TO BE USED TOWARD THE PURCHASE OF A HP LASERJET PRINTER OR A REBATE COUPON TO BE USED TOWARD THE PURCHASE OF HP MEDIA AS DEFINED BELOW. ALL COUPONS MUST BE USED

2 AT THE HP ON-LINE STORE, SEE OR [GOVERNMENT CLASS MEMBERS, DEFINED AS ANY FEDERAL, STATE OR LOCAL GOVERNMENT ENTITY, ARE EXCLUDED FROM THE ON-LINE REQUIREMENT.] PLEASE CHOOSE ONLY ONE ALTERNATIVE REMEDY FOR EACH PRINTER UNIT YOU OWN, OTHERWISE YOUR CLAIM FORM WILL BE REJECTED AND RETURNED TO YOU

3 Step #1: YOU MUST COMPLETE THE DESIGNATED SECTIONS BELOW AND RETURN TO: HP CLAIMS CENTER P O Box 8016 Young America, MN ?? COMPLETE THE FOLLOWING: First name Middle name Last name Street address Apt # City State Zip code ( ) Daytime Telephone Number ( ) Home Telephone Number address (Your is not required, but it will assist us in providing you information relevant to your claim form and rebate certificate). Step #2 IDENTIFICATION OF UNIT Please identify the model number and serial number of your printer(s). If you are submitting claims for multiple printers, please use a separate sheet of paper to list the serial number and date of manufacture for each printer. Model Number of Unit (check one or enter the number of printers in each category if you own more than one printer unit) 1100 Series 5L 6L (a) (b) (c) (d) (e) Serial Number of Unit (located on the back of unit; enter serial number for each printer unit) Date of Manufacture (m/d/y) (located on the back of unit) (include date of manufacturer for each printer unit) - 3 -

4 Step #3: PROOF OF OWNERSHIP (Complete one of the following, check where appropriate.) I. DOCUMENTATION I am attaching proof of purchase with the following documents: (check all that apply) A legible copy of a contemporaneously dated Purchase Receipt which identifies the purchase of my HP LaserJet printer from a retail seller; or, An Invoice marked paid which identifies the seller and the seller s address and the purchase date of my HP LaserJet printer; or, A Cancelled Check along with a document identifying the purchase of my HP LaserJet printer; or, A Credit Card bill or receipt which identifies the purchase of my HP LaserJet printer. II. WARRANTY REGISTRATION I purchased a HP LaserJet printer that I believe was manufactured between September 1, 1995 and June 30, 2000, but do not have any of the documentation listed above. I believe that I registered my HP LaserJet printer with HP. (If your address was different at the time of warranty registration please provide your former address at the time of registration: ) III. BY GIFT I received my HP LaserJet printer as a gift and I believe it was manufactured between September 1, 1995 and June 30, I do not have any of the documentation listed above. I am providing the name, address and telephone number of the person who gave me the HP LaserJet printer: Name Street Address City State Zip Code ( ) Telephone Number - 4 -

5 Step #4: DETERMINE SETTLEMENT SUBCLASS (Note You May Be In More Than One Subclass If You Own Multiple Printers If You Are In Different Subclasses, Please Identify The Printers And Respective Subclasses On A Separate Page And Complete The Required Information For Each Subclass) SUBCLASS A (enter # of printers in this subclass) Current or former owners who repaired HP Printers as defined with Proof of Purchase and proof of repair(s) of the multifeed problem. SUBCLASS B (enter # of printers in this subclass) Current or former owners of HP printers as defined with proof of purchase who experienced the multifeed problem and who did not repair or who have no proof of repair. SUBCLASS C (enter # of printers in this subclass) Current owners of the HP printer with proof of purchase who have not experienced the multifeed problem. Step #5: COMPLETE THE REQUIREMENTS FOR YOUR SETTLEMENT SUBCLASS (See Following Pages & Complete only the sections of the Subclass requirements for which you qualify.) Step #6: WHEN YOU ARE FINISHED: DOUBLE CHECK THAT YOUR DOCUMENTS ARE COMPLETE:?? Did you provide all the documentation necessary to prove Purchase or an Identifiable Gift Transfer??? If you are proving purchase through the warranty database or through affidavit only, have you signed the appropriate affidavits for each Subclass to which you belong??? If you are claiming to be in Subclass A, did you provide all the necessary documentation to prove your payment for repair??? Did you indicate to which Subclass or Subclasses you belong and did you provide a list of the Printers you claim belong in each Subclass? - 5 -

6 SUBCLASS A REQUIREMENTS: Complete Steps A, B, C, D and E of the following: A. I AM SUBMITTING THIS CLAIM FOR PRINTER(S). (insert #) B. PROOF OF PAYMENT OF REPAIR (Must be Completed for Subclass A Remedy ONLY) I have paid to have my HP LaserJet printer repaired due to the Multifeeding Problem. I am attaching copies of contemporaneously generated and dated repair bills, invoices, or receipts containing the diagnosis or statement of a Qualified Repair Person of the Multifeeding Problem as being the cause for the repair of the repaired HP LaserJet printer, and indicating how much I have paid for the repair. The name and address of the Qualified Repair Person is C. AFFIRMATION OF NO PRIOR SETTLEMENT (Initials) I have never been reimbursed by HP for any repairs I have made for a Multifeeding Problem with the above HP LaserJet printer. (Initials) I received reimbursement by HP for repairs made for a Multifeeding problem with the above HP LaserJet printer in the amount of $ on or about (month and year received). D. I REQUEST: (SELECT ONLY ONE COUPON PER CLAIM/PER PRINTER UNIT) (1) A $70 PRINTER REBATE COUPON, OR (2) A $35 MEDIA REBATE COUPON (With A Minimum Purchase Requirement Of $60) E. AFFIDAVIT UNDER PENALTY OF PERJURY I attest under the penalty of perjury that: 1. I purchased or lawfully owned (or I am an authorized representative of the lawful owner) the HP LaserJet printer identified in this Claim Form. 2. I am eligible to request one of the Remedies relating to the HP LaserJet printer covered by this Claim Form. 3. Any documents submitted with this Claim Form are true and correct copies of the originals. 4. I have not requested, and will not request, exclusion from the Settlement Class for the HP LaserJet printer identified in this Claim Form, and I have not previously filed a Claim Form with respect to the HP LaserJet printer identified in this Claim Form. 5. I have read and understand the contents of this Claim Form

7 6. I hereby release HP and all Released Parties (as defined in the Settlement Agreement and Settlement Notice) from all claims associated with the HP Printer that is the subject of this Claim Form. 7. The statements made in the Claim Form are true and correct to the best of my knowledge. I realize that if any of them are willfully false, I am subject to punishment under perjury statutes. Signature Date Print Name - 7 -

8 SUBCLASS B1 REQUIREMENTS: (Subclass B1 is 5L HP Printers only) Complete Steps A, B, C, and D of the following: A. I AM SUBMITTING THIS CLAIM FOR PRINTER(S). (insert #) B. AFFIRMATION OF NO PRIOR SETTLEMENT (Initials) I have never been reimbursed by HP for any repairs I have made for a Multifeeding Problem with the above HP LaserJet printer. (Initials) I received reimbursement by HP for repairs made for a Multifeeding problem with the above HP LaserJet printer in the amount of $ on or about (month and year received). C. I REQUEST: (SELECT ONLY ONE COUPON PER CLAIM/PER PRINTER UNIT) (1) A $30 PRINTER REBATE COUPON, OR (2) A $15 MEDIA REBATE COUPON (With A Minimum Purchase Requirement Of $30) D. AFFIDAVIT UNDER PENALTY OF PERJURY I attest under the penalty of perjury that: 1. I purchased or lawfully owned (or I am an authorized representative of the lawful owner) the HP LaserJet printer identified in this Claim Form. 2. I experienced the Multifeed Problem in that my HP LaserJet printer had significant and prolonged performance problems that resulted from the printer's consistent feeding of more than one piece of paper at a time and/or frequent or habitual paper jamming or inability to print multiple page documents. To the best of my knowledge, the problem was not due to abuse, neglect or act of God. 3. I am eligible to request one of the Remedies relating to the HP LaserJet printer covered by this Claim Form. 4. Any documents submitted with this Claim Form are true and correct copies of the originals. 5. I have not requested, and will not request, exclusion from the Settlement Class for the HP LaserJet printer identified in this Claim Form, and I have not previously filed a Claim Form with respect to the HP LaserJet printer identified in this Claim Form. 6. I have read and understand the contents of this Claim Form. 7. I hereby release HP and all Released Parties (as defined in the Settlement Agreement and Settlement Notice) from all claims associated with the HP Printer that is the subject of this Claim Form

9 8. The statements made in the Claim Form are true and correct to the best of my knowledge. I realize that if any of them are willfully false, I am subject to punishment under perjury statutes. Signature Date Print Name - 9 -

10 SUBCLASS B2 REQUIREMENTS: (Subclass B2 is 6L, 3100, 3150 and 1100 series HP Printers only.) Complete Steps A, B, C, D and E of the following: A. I AM SUBMITTING THIS CLAIM FOR PRINTER(S). (insert #) B. REPAIR KIT REMEDY (6L, 3100, 3150 and 1100 Series Only) I have already received a HP Repair Kit (a.k.a the T-tool or L-tool). I have not received a HP Repair Kit (a.k.a. the T-tool or L-tool), but do not request one. I have not received a HP Repair Kit (a.k.a the T-tool or L-tool) and request one because I presently own this printer. C. AFFIRMATION OF NO PRIOR SETTLEMENT (Initials) I have never been reimbursed by HP for any repairs I have made for a Multifeeding Problem with the above HP LaserJet printer. (Initials) I received reimbursement by HP for repairs made for a Multifeeding problem with the above HP LaserJet printer in the amount of $ on or about (month and year received). D. I REQUEST: (SELECT ONLY ONE COUPON PER CLAIM/PER PRINTER UNIT) (1) A $20 PRINTER REBATE COUPON (2) A $10 MEDIA REBATE COUPON (With A Minimum Purchase Requirement Of $20) E. AFFIDAVIT UNDER PENALTY OF PERJURY I attest under the penalty of perjury that: 1. I purchased or lawfully owned (or I am an authorized representative of the lawful owner) the HP LaserJet printer identified in this Claim Form. 2. I experienced the Multifeed Problem in that my HP LaserJet printer had significant and prolonged performance problems that resulted from the printer's consistent feeding of more than one piece of paper at a time and/or frequent or habitual paper jamming or inability to print multiple page documents. To the best of my knowledge, the problem was not due to abuse, neglect or act of God. 3. I am eligible to request one of the Remedies relating to the HP LaserJet printer covered by this Claim Form. 4. Any documents submitted with this Claim Form are true and correct copies of the originals

11 5. I have not requested, and will not request, exclusion from the Settlement Class for the HP LaserJet printer identified in this Claim Form, and I have not previously filed a Claim Form with respect to the HP LaserJet printer identified in this Claim Form. 6. I have read and understand the contents of this Claim Form. 7. I hereby release HP and all Released Parties (as defined in the Settlement Agreement and Settlement Notice) from all claims associated with the HP Printer that is the subject of this Claim Form. 8. The statements made in the Claim Form are true and correct to the best of my knowledge. I realize that if any of them are willfully false, I am subject to punishment under perjury statutes. Signature Date Print Name

12 SUBCLASS C REQUIREMENTS: Complete Steps A, B, C and D of the following: A. I AM SUBMITTING THIS CLAIM FOR PRINTER(S). (insert #) B. REPAIR KIT REMEDY I have already received a HP Repair Kit (a.k.a the T-tool or L-tool). I have not received a HP Repair Kit (a.k.a. the T-tool or L-tool), but do not request one. I have not received a HP Repair Kit (a.k.a the T-tool or L-tool) and request one because I presently own this printer. C. AFFIRMATION OF NO PRIOR SETTLEMENT (Initials) I have never been reimbursed by HP for any repairs I have made for a Multifeeding Problem with the above HP LaserJet printer. (Initials) I received reimbursement by HP for repairs made for a Multifeeding problem with the above HP LaserJet printer in the amount of $ on or about (month and year received). D. AFFIDAVIT UNDER PENALTY OF PERJURY I attest under the penalty of perjury that: 1. I purchased or lawfully owned (or I am an authorized representative of the lawful owner) the HP LaserJet printer identified in this Claim Form. 2. I am eligible to request one of the Remedies relating to the HP LaserJet printer covered by this Claim Form. 3. Any documents submitted with this Claim Form are true and correct copies of the originals. 4. I have not requested, and will not request, exclusion from the Settlement Class for the HP LaserJet printer identified in this Claim Form, and I have not previously filed a Claim Form with respect to the HP LaserJet printer identified in this Claim Form. 5. I have read and understand the contents of this Claim Form. 6. I hereby release HP and all Released Parties (as defined in the Settlement Agreement and Settlement Notice) from all claims associated with the HP Printer that is the subject of this Claim Form. 7. The statements made in the Claim Form are true and correct to the best of my knowledge. I realize that if any of them are willfully false, I am subject to punishment under perjury statutes

13 Signature Date Print Name