Toshiba TOCF#1026 manual Proof of Purchase or Receipt of Toshiba DVD Player AT Issue

❏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 At Issue with a DVD player made by another manufacturer that you specifically purchased as a result of the Playback Incompatibility, you will receive a Rebate Certificate if you provide all of the required information and documentation. Specifically, you must: (1) provide documentation of your original purchase or receipt of the Toshiba DVD Player, and (2) provide proof of purchase of a replacement DVD player, dated before the date of the Settlement Agreement and after the date of the purchase of the Toshiba DVD player, and (3) declare under penalty of perjury that the exclusive and direct cause of your purchase of a non-Toshiba DVD player was the actual manifestation of one or more Playback Incompatibilities.

(1)PROOF OF PURCHASE OR RECEIPT OF TOSHIBA DVD PLAYER AT ISSUE

TO SHOW THAT I PURCHASED OR ACQUIRED A TOSHIBA DVD PLAYER ON OR BEFORE DECEMBER 31, 2001, I AM ATTACHING THE FOLLOWING DOCUMENTS (check all that apply):

_____ A legible copy of the original and contemporaneously dated purchase receipt which identifies the purchase of a Toshiba DVD player from a retail seller;

_____ An invoice marked “paid” which identifies the retail seller, the seller's address and the purchase of a Toshiba DVD player;

_____	A canceled check contemporaneously identifying the purchase of a Toshiba DVD
	player;
_____	A credit card bill which identifies the purchase of a Toshiba DVD player.

(2)PROOF OF PURCHASE OF A REPLACEMENT DVD PLAYER

TO SHOW THAT I PURCHASED A REPLACEMENT DVD PLAYER FROM ANOTHER MANUFACTURER ON OR BEFORE OCTOBER 15, 2004 AND AFTER THE DATE OF THE PURCHASE OF A TOSHIBA DVD PLAYER, I AM ATTACHING THE FOLLOWING DOCUMENTS (check all that apply):

_____	A legible copy of the original and contemporaneously dated purchase receipt which
	identifies the purchase of another DVD player from a retail seller;
_____	An invoice marked “paid” which identifies the retail seller, the seller's address and
	the purchase of another DVD player;
_____	A canceled check contemporaneously identifying the purchase of another DVD
	player;
_____	A credit card bill which identifies the purchase of another DVD player.

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ToCF#1026