ページ1に含まれる内容の要旨
TOSHIBA DVD CLASS ACTION SETTLEMENT CLAIM FORM INSTRUCTIONS
THE DEADLINE FOR FILING A CLAIM FORM IS: MAY 1, 2005
1. IT IS IMPORTANT TO READ AND FOLLOW THESE INSTRUCTIONS CAREFULLY. FAILURE TO FOLLOW THE
INSTRUCTIONS COULD RESULT IN LOSING BENEFITS TO WHICH YOU WOULD OTHERWISE BE ENTITLED.
PLEASE REVIEW THE CLASS NOTICE FOR DEFINITIONS OF CERTAIN TERMS USED IN THIS FORM.
2. IF YOU DO NOT RETURN A COMPLETED CLAIM FORM POSTMARKED BY MAY 1, 2005 YOUR CLAIM WILL
BE REJECTED AND YOU WILL HAVE WAIVED
ページ2に含まれる内容の要旨
TOSHIBA DVD CLASS ACTION SETTLEMENT CLAIM FORM THE DEADLINE FOR FILING A CLAIM FORM IS MAY 1, 2005 PLEASE PRINT CLEARLY, SIGN YOUR NAME AT THE BOTTOM OF THIS FORM AND MAIL TO: DVD Player Claims Administrator c/o The Notice Company P.O. Box 778 Hingham, MA 02043 SECTION A: CLAIMANT INFORMATION First Name Middle Initial Last
ページ3に含まれる内容の要旨
SECTION C: PRIOR ACCOMMODATION OR COMPENSATION Check all categories that apply: ❏ I have never been reimbursed for any firmware upgrades, or been provided with any other relief, for Playback Incompatibilities with my Toshiba DVD Player at Issue. ❏ I received reimbursement or refund of $________ for a firmware upgrade (or upgrades) that I paid for resulting from Playback Incompatibilities with my Toshiba DVD Player at Issue. ❏ I received a free replacement DVD player from Toshiba. ❏ I received
ページ4に含まれる内容の要旨
Issue. I am filing this Claim Form because my current address may be different from the address contained in Norman’s Electronics, Inc.’s records. ❏ I paid either Toshiba or a third party service center (other than Norman’s Electronics, Inc.) to upgrade the firmware on the Toshiba DVD Player At Issue specifically to resolve Playback Incompatibilities experienced with the Toshiba DVD Player At Issue. I am attaching copies of original, contemporaneously generated and dated documents (such as a b
ページ5に含まれる内容の要旨
❏ I have chosen the rebate certificate remedy and have not selected any of the other remedies listed on this Claim Form. ❏ I declare under penalty of perjury that the Toshiba DVD Player At Issue experienced one or more Playback Incompatibilities on or before October 15, 2004. If you experienced a Playback Incompatibility with the Toshiba DVD Player at Issue and you replaced the Toshiba DVD Player at Issue on or before October 15, 2004 and after the date of the purchase of the Toshiba DVD Player
ページ6に含まれる内容の要旨
(3) DECLARATION OF CAUSATION ❏ By checking this box, I hereby affirm, under penalty of perjury, that the exclusive and direct reason for my purchase of the non-Toshiba DVD player was the manifestation of Playback Incompatibilities on the Toshiba DVD Player at Issue. AFFIDAVIT UNDER PENALTY OF PERJURY I attest under the penalties of perjury that: 1. I purchased or acquired the Toshiba DVD Player at Issue on or before October 15, 2004. 2. I am eligible to request the remedy that I am seeking by su
