CLAIM FORM - Margaret Stevens v. Britax Child Safety, Inc.

I. GENERAL INSTRUCTIONS

If you were a California resident when you purchased for personal or household use a new Britax Frontier ClickTight Harness-2-Booster Seat or Britax Pioneer Harness-2-Booster Seat (the “Class Child Seats”) at any time from August 14, 2016 up to and including August 14, 2020 with a manufacturing date from August 14, 2016 to no later than September 30, 2019, then you are a “Settlement Class Member” and entitled to make a Claim. As a Settlement Class Member:

1. You are entitled to receive $40 for each purchase of a Class Child Seat that you made.

The deadline to submit this Claim Form is August 10, 2022.

In order for your Claim to be approved you must submit either of the following:

1. A receipt or other document confirming the purchase of a Class Child Seat and the date of purchase;

2. Identification of the serial number for the Class Child Seat and the manufacturing date (which must be between August 14, 2016 and September 30, 2019).

You can locate the manufacturing dates for a Class Child Seat here.

II. CLAIMANT INFORMATION

The Settlement Administrator will use this information for all communications regarding this Claim Form and the Settlement. 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.

First Name

Last Name

Address 1

Address 2

City

State

Zip

Country

Phone Number

Confirm Email

In addition, you must (i) sign the declaration in Section IV of this Claim Form; and (ii) submit reasonable documentation demonstrating your purchase of one or more Class Child Seats, such as a retailers’ receipt or credit card receipt confirming purchase of a Class Child Seat or a photo of the Class Child Seat showing the serial number and manufacturing date of the Class Child Seat between August 14, 2016 and September 30, 2019. The serial number can be found in the location identified in the photograph below, marked by the blue arrow.

Example:

Upload Proof of Purchase

You can select up to 3 files; The files must be selected together. Files must be of type .pdf, .png, .jpg, .jpeg and be less than 5 Mb each.

III. PAYMENT

In the event your claim is valid and you qualify to receive a monetary payment, you will receive an email at the email address provided in Section II above after Final Approval.

Please select the method by which you would like to receive the payment.

IV. ATTESTATION

I declare that I am a California resident or was a California resident at the time that I purchased one or more Class Child Seats from August 14, 2016 up to and including August 14, 2020. I declare under penalty of perjury under the laws of California and of the United States of America that the foregoing is true and correct. Excuted in, , .

Type Name Here

Date Signed

Margaret Stevens v. Britax Child Safety, Inc.

United States District Court Central District of California
Case No. 2:20-cv-07373-MCS-AS

Submit a Claim by August 10, 2022