Submit Claim | RB Settlement

Please click the link for GENERAL INSTRUCTIONS

Please read all of the following instructions carefully before filling out your Claim Form.

Complete Part A (“Claimant Information”) by filling in the requested information. Only one Claim Form per household will be honored. Household means all Persons who share a single physical address.
Complete Part B by providing the number of purchases of each kind of Neuriva Product you purchased between January 1, 2019 and April 23, 2021. For example, if you purchased one bottle of Neuriva^® Original of any size during the class period, you would fill in the number “1” on the line that corresponds with Neuriva^® Original, all sizes. You must then check a box to indicate if you have proof of purchase or not. Each qualifying purchase will receive a payment as defined in the Settlement Agreement, subject to the following limit: (1) Those with proof(s) of purchase deemed valid by the Settlement Administrator and who submit it with the claim form may obtain a payment up to $65.00 per Class Member; and (2) Those with no proof of purchase may obtain payment up to $20.00 per Class Member.
Proof of purchase means acceptable documentation that provides valid proof of your purchase of Neuriva Products. Such valid proof of purchase documentation may consist of receipts, copies of receipts, invoices, direct purchase records, or other legitimate proof showing payment to either a retailer or Reckitt Benckiser for any of the Neuriva Product that was not used as proof for any other claim.
The claims purchases must be direct retail purchases and not made for purposes of resale, commercial use, or any other purpose.
Sign the CLAIM FORM.
Once your Claim Form is received, the Settlement Administrator will review the Claim Form for compliance and fraud prevention. Keep a copy of your completed Claim Form for your records. If your claim is rejected for any reason, the Settlement Administrator will notify you by U.S. mail or e-mail of the rejection and the reasons for such rejection; you will be allotted 30 days from receipt of a denial to cure any deficiency.

PART A – CLAIMANT INFORMATION

First Name *

Last Name *

Email Address *

Phone Number

Street Address (Mailing Address) *

City *

State *

Zip Code *

* Required Fields

PART B – LIMITED REIMBURSEMENT FOR QUALIFYING HOUSEHOLDS

You may make a claim for the following Neuriva® Products:

Neuriva^® Original, all sizes
Neuriva^® Plus, all sizes
Neuriva^® De-Stress, all sizes

PLEASE FILL OUT THIS CHART STATING YOUR PURCHASES

Type of Product Purchased	Number of Each Type of Product Purchased	Approximate Date of Purchase(s)	Name of Store and City or Website of Product Purchased	Approximate Price(s) of Purchase(s)
Neuriva^® Original any size	Number of Each Type of Product Purchased	Approximate Date of Purchase(s)	Name of Store and City or Website of Product Purchased	Approximate Price(s) of Purchase(s)
Neuriva^® Plus, any size	Number of Each Type of Product Purchased	Approximate Date of Purchase(s)	Name of Store and City or Website of Product Purchased	Approximate Price(s) of Purchase(s)
Neuriva^® De-Stress any size	Number of Each Type of Product Purchased	Approximate Date of Purchase(s)	Name of Store and City or Website of Product Purchased	Approximate Price(s) of Purchase(s)

CHECK AND COMPLETE ONLY ONE OF THE FOLLOWING:

I HAVE PROOF OF PURCHASE (i.e., sales receipt(s) or invoice(s)) showing that I purchased Neuriva between January 1, 2019 and April 23, 2021. I understand that a qualifying Class Member who submits a valid claim form and valid proof of purchase for all qualifying purchases is entitled to receive payment in the amounts above for each purchase up to $65.00 per Class Member, limited to one Class Member per household. YOU MUST ATTACH THE PROOF OF PURCHASE WITH YOUR CLAIM FORM.

I DO NOT HAVE ANY PROOF OF PURCHASE (i.e., a sales receipt or invoice) showing that I purchased Neuriva between January 1, 2019 and April 23, 2021. I understand that a qualifying Class Member who submits a valid claim form without proof of purchase is entitled to receive payment in the amounts above for each purchase up to $20.00 per Class Member, limited to one Class Member per household.

I swear and affirm under the penalty of perjury that the above is true to the best of my knowledge.

Signature *

Date

Williams, et al. v. Reckitt Benckiser LLC, et al.

Docket No.: 1:20-cv-23564

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA MIAMI DIVISION

Please click the link for GENERAL INSTRUCTIONS

Please review your claim details below.

Your Claim Form has been submitted successfully.

CLAIM INFORMATION
First Name
Last Name
Email Address
Phone Number
Street Address (Mailing Address)
City
State
Zip Code

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
Last Name
Email Address
Phone Number
Street Address (Mailing Address)
City
State
Zip Code