Claim Form

To upload a copy of your Claim Form online, please enter your Unique ID below. The Unique ID is located on the personalized Claim Form that was included with the Notice you received.
If you had more than one Covered Loss during the Class Period (March 8, 2011 through August 3, 2017), then you received separate Claim Forms for those losses. In order to be eligible for payment on those losses, you must complete and submit the Claim Form for each loss. If you would like to upload these Claim Forms online, please upload each Claim Form separately using the Unique ID provided for each respective loss.
Claim Forms must be submitted or timely postmarked (if submitted by mail) to the Administrator no later than October 24, 2022.
If you have any questions, please contact the Administrator at