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

If you have an ID and Confirmation Code, please enter the codes below to complete a claim.

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

  1. 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.
  2. 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.
  3. 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.
  4. The claims purchases must be direct retail purchases and not made for purposes of resale, commercial use, or any other purpose.
  5. Sign the CLAIM FORM.
  6. 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
* Required Fields
PART B – LIMITED REIMBURSEMENT FOR QUALIFYING HOUSEHOLDS

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

  1. Neuriva® Original, all sizes
  2. Neuriva® Plus, all sizes
  3. 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
Neuriva® Plus, any size
Neuriva® De-Stress any size

CHECK AND COMPLETE ONLY ONE OF THE FOLLOWING:

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

    Please review your claim details below.

    Your Claim Details

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

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@RBSettlement.com.

    Please print this page for your records.

    Your Claim Details

    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
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@RBSettlement.com