Sign & Date Clause Samples

Sign & Date. All the information that I (we) supplied in this Tire Rotation Claim Form is true and correct to the best of my (our) knowledge and belief and this document is signed under penalty of perjury. Signature Date

Sign & Date. All the information that I (we) supplied in this Tire Replacement Claim Form is true and correct to the best of my (our) knowledge and belief and this document is signed under penalty of perjury. Signature Date

Sign & Date. All the information that I (we) supplied in this Claim Form is true and correct to the best of my (our) knowledge and belief, and this document is signed under penalty of perjury. This Claim Form and all required documents/paperwork must be submitted through ▇▇▇.▇▇▇▇▇▇.▇▇▇ by JND Legal Administration [Address] UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY If you currently or previously owned or leased a certain Volkswagen vehicle listed below in the United States or Puerto Rico, you may be entitled to benefits afforded by a class action settlement. This notice is being mailed to you because you have been identified as owning or leasing such a vehicle.

Sign & Date. ADDITIONAL CONDITIONS OF HIRE DURING COVID-19

Sign & Date. The information on this form is true and correct to the best of my knowledge. I agree to participate in the settlement. I authorize any dealership that serviced my vehicle to release records to Hyundai to help pay my claim. To the extent I am seeking reimbursement for a dealership repair and do not have a receipt or other documentation for the corresponding cash payment, I attest under penalty of perjury that I (or a friend or family member) paid for the repair in cash and I do not have a receipt or documentation for the payment. Signature: Date: [6] Submit: Email the completed form and the documentation to ▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇.▇▇▇ or mail it to ▇.▇. ▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇, ▇▇▇▇▇. For more information please view the Class Notice or visit ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇ A court has authorized this notice. You have received this notice because Hyundai’s records indicate that you are a current or former owner or lessee of a U.S. specification model-year 2015 to 2017 Hyundai Sonata vehicle. This is not a solicitation from a lawyer. • A nationwide settlement (“Settlement”) has been reached in a class action lawsuit against Hyundai Motor America (“HMA”). The lawsuit concerns model year 2015 to 2017 U.S. specification Hyundai Sonata vehicles equipped with the Smart Trunk feature purchased or leased in the fifty United States or the District of Columbia (“Class Vehicles”). The lawsuit alleges that the Smart Trunk on the Class Vehicles is defective because it does not open a sufficient amount. Defendant has denied these allegations. • The Settlement provides an opportunity to be reimbursed for certain past expenses, to obtain a free inspection and repair of the affected trunk components, and to receive a cash payment or a HMA dealer credit. • Your legal rights are affected whether you act or don’t act, so please read this notice carefully. SUBMIT A CLAIM AND/OR TAKE YOUR CLASS VEHICLE TO AN AUTHORIZED HMA DEALER Make a claim for relief so that you may be able to receive the valuable benefits available to you under the Settlement and/or take your vehicle to an authorized HMA Dealer after the Settlement is approved. Claims must be submitted by . See Question 10, below. You must bring your Class Vehicle to an authorized Hyundai Dealer after the Settlement is approved. See Question 8, below. EXCLUDE YOURSELF Get no reimbursement for out-of- pocket expenses. This is the only option that allows you to be part of any other lawsuit, or your own lawsuit...

Sign & Date. Read the Agreement in Part III on page 1. The Applicant(s) and anyone aged 19 years or over who is living at the rental unit must sign the Application for Housing Benefits.