United States District Court Western District of Washington at Seattle
Case No. 2:23-cv-00543-RAJ
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Peterson et al. v. BSH Home Appliances Corporation
Submit Claim
PART ONE: CLAIMANT INFORMATION
Provide your name and contact information below. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form.
Yes
No
First Name
Last Name
Address 1
Address 2
City
None
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
Nebraska
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New Hampshire
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North Carolina
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Ohio
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Pennsylvania
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip
Phone Number
Email
Confirm Email
Please read the full
Notice
for more information regarding Settlement benefits before filling out this Claim Form.
Tier 1:
If you had a Display Failure on or before March 7, 2024, you may qualify under Tier 1 benefits of this settlement including:
Tier 1(a) Reimbursement up to $400.00 for out-of-pockets expenses if documentation is provided.
(Expired)
Tier 1(b) Extended service plan benefit of three (3) years from the date of purchase.
Tier 2:
If you had a Display Failure after
March 7, 2024,
you may qualify for an Extended service plan benefit of three (3) years from the date of purchase of your product. Documentation is required.
Did you experience a display failure after
March 7, 2024
?
Yes
No
PART TWO: CLAIM INFORMATION
Please provide the following information for your Class Product:
HBL5751UC
HBL8751UC
HBLP751UC
HMC80151UC
HMC80251UC
HMC87151UC
Model Number of Class Product Microwave/Oven
Serial Number of Class Product Microwave/Oven
PROOF OF OWNERSHIP
1. Are you a resident of the United States or its territories who purchased, received as a gift, or acquired as part of the purchase or remodeling of a home, a new Class Product (i.e., a Bosch-manufactured microwave/oven combination with a model and serial number listed as eligible for settlement benefits in the Class Notice)?
Yes
No
2. Do you have documentation showing that you purchased a new Class Product, or acquired a new Class Product as part of a purchase or remodel of a home, or received a new Class Product as a gift?
Yes
No
You MUST gather and upload your documents, or you will not be entitled to any compensation or benefit under this Settlement.
Upload
0
Files
ProofofOwnerShipFiles
PROOF OF PAST DISPLAY FAILURE
To be eligible for Tier 1(a) and Tier 1(b) benefits, please complete the following.
3. Do you have documentation showing that your Class Product experienced a Display Failure?
Yes
No
You MUST gather and upload your documents, or you will not be entitled to any compensation or benefit under this Settlement.
Upload
0
Files
ProofofPastDisplayFailure
PROOF OF OUT-OF-POCKET EXPENSES
4. Do you have documentation showing you paid out-of-pocket to repair or replace your Class Product in response to any VFD control panel that experienced a Display Failure?
Yes
No
You MUST gather and upload your documents, or you will not be entitled to any compensation or benefit under this Settlement.
Upload
0
Files
ProofofDOutofPocketExpenses
POTENTIAL CASH PAYMENT
Based on your responses above, you may be entitled to receive a cash payment of up to $400.00 if you provide sufficient proof.
* The cash payments set out herein represent the maximum you can receive under the settlement. The actual cash paid may be reduced depending on the aggregate total of claims submitted by all Settlement Class Members.
Please select a payment method:
Payment Options
You have successfully submitted your payment details.
PROOF OF DISPLAY FAILURE
3. Do you have documentation showing that your Class Product experienced a Display Failure?
Yes
No
You MUST gather and upload your documents, or you will not be entitled to any compensation or benefit under this Settlement.
Upload
0
Files
ProofofDisplayFailure
You are not entitled to any benefit under Tier 2 of this Settlement at this time.
PART THREE: DECLARATION AND CERTIFICATION STATEMENTS
PROOF OF OWNERSHIP DECLARATION
I declare under penalty of perjury of the laws of the United States that I have searched for but am unable to find documentary proof, but that I qualify for membership in the class because I either purchased a new Class Product, acquired a new Class Product as part of a purchase or remodel of a home, or received a new Class Product as a gift.
PROOF OF DISPLAY FAILURE DECLARATION
I declare under penalty of perjury of the laws of the United States that I have searched for but am unable to find documentary proof of Past Display Failure, but that I qualify for membership in the class because my Class Product experienced a Display Failure.
CERTIFICATION STATEMENT
I declare under penalty of perjury of the laws of the United States that all information provided in this Claim Form is true and accurate.
Signature
Date
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