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ToCF#1026
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 Name
Street Address
City State Zip Code
( )
( )
Daytime Telephone Number Home Telephone Number
Email address (Your email address is not required, but if you do provide it, you authorize the Claims
Administrator to use it in providing you information relevant to your Claim Form.)
SECTION B: IDENTIFICATION OF YOUR DVD PLAYER AT ISSUE
Important: Only one DVD player per Claim Form. The Claims Administrator will reject Claim Forms
that list multiple DVD Players.
Model Number of your Toshiba DVD Player At Issue (located on the front of your DVD unit)
Serial Number of your Toshiba DVD Player At Issue (located on the back of your DVD Unit)
Firmware Version of your Toshiba DVD Player At Issue, if available (this number is usually located
on the sticker attached to the bottom of your DVD Player)