Allen et al. v. Similasan Corp.

Case No. 12-cv-00376-BAS-JLB

United States District Court, Southern District of California

Claim Form

To print a paper version of the Claim Form, click here.

YOU MUST SUBMIT YOUR CLAIM FORM NO LATER THAN SEPTEMBER 7, 2017.

PERSONAL INFORMATION

First Name

Last Name

Email Address

Telephone Number

Address

City

State

Zip

CONFIRMATION OF CLASS MEMBERSHIP

I declare the following (choose one):

1

I purchased a Similasan Product between February 10, 2008 and April 12, 2017, and the Product I purchased did not provide relief. I do not have a receipt for my purchase.

1

I purchased a Similasan Product between February 10, 2008 and April 12, 2017, and the Product I purchased did not provide relief. I am attaching documentation of my purchase in the form of a receipt or itemized credit card or itemized bank statement.
Please attach copies of any supporting documents (e.g. receipts, product packaging, etc) if available.

SIGN YOUR CLAIM FORM

I agree that by submitting this Claim Form I certify under penalty of perjury of the laws of the United States of America that the foregoing is true and correct to the best of my knowledge and that checking this box constitutes my electronic signature on the date of its submission.