Class Action Claim Form

Draft an enforceable claim form enabling lay claimants to submit settlement claims while satisfying FRCP 23, court orders, and the settlement agreement.

Prerequisites

Gather before drafting:

Settlement agreement — approved or pending, with class definition, claim categories, compensation structure
Court orders — preliminary/final approval with any form-specific requirements
Class definition — precise membership criteria (dates, transactions, geography)
Administrator details — name, address, email, phone, website
Release scope — released parties, released claims, statutory waiver requirements

Quick Start

Confirm jurisdiction (FRCP 23 vs. state equivalent) and adapt statutory language accordingly
Draft each section below in order
Write at 8th-grade reading level — short sentences, active voice, defined terms
Do not simplify release or certification language to the point of unenforceability
Run the checks in Pitfalls before finalizing

Form Sections

1. Header & Case Identification

Title: "OFFICIAL CLAIM FORM" — bold, prominent
Full case caption, court name, docket number
Administrator contact (mail, email, phone, website)
Deadline: bold, specific date/time with timezone; state postmark vs. receipt rule
Intro paragraph: plain-language eligibility summary, reference to settlement agreement date and approval order

2. Claimant Information

Structured fields:

Full legal name (as during class period), current name if different
Current address, email, phone, alternative contact
Class-specific identifiers: purchase dates, account numbers, employment periods — explain why each is needed
Special claimants (if applicable): deceased (executor + authority docs), minors/incapacitated (guardian + docs), entities (name + authorized rep)
Privacy disclosure: how personal information will be used and protected

3. Claim Details & Documentation

Per claim category from the settlement:

Checkbox, category description, applicable date range
Fields for amount/damages, reference number, description of harm

Documentation tiers:

| Claim Amount | Required | Acceptable Forms | |---|---|---| | Under threshold | Declaration only | N/A | | Above threshold | Submit with form | Receipts, statements, contracts, correspondence |

Specify copies acceptable (not originals). Include false-information warning (claim denial, civil penalties, criminal prosecution).

4. Certification & Release

Certification — under penalty of perjury, claimant affirms:

Information is true, accurate, and complete
Claimant meets the class definition
Claims not previously released; no prior compensation received
Bound by settlement terms and court orders

Release (separate section, own acknowledgment checkbox):

List all released parties (defendants, affiliates, officers, directors, agents, successors)
Describe released claims — enforceable specificity, lay-reader clarity
Include statutory waiver for unknown claims where applicable (e.g., Cal. Civ. Code § 1542 — verify jurisdiction)
State consequences: bound by settlement/judgment, waive separate suit, bound by appeals

5. Signature Block

Signature line, date, printed name
Title/relationship field for representatives
Note electronic signatures acceptable if e-filing permitted
Representatives must state authority and relationship

6. Submission Instructions

| Method | Details | |---|---| | Mail | Full address; postmark by deadline | | Email | Address; received by deadline with timezone | | Online | URL; uploaded by deadline with timezone |

Include: receipt confirmation process, what to do if no confirmation within stated business days, post-submission timeline (review, notification, challenge process).

Remind claimant: retain copies of form and all supporting documentation.

Pitfalls & Checks

Required disclaimers: (1) submission does not guarantee payment; (2) settlement subject to court approval; (3) attorney fees/costs deducted as applicable
Accessibility: screen-reader compatible; note if translations required for the class
Page formatting: number all pages; case name/number in header/footer; if >2 pages, add first-page checklist
No legal advice: form must not constitute or appear to constitute legal advice
Jurisdiction: confirm FRCP 23 vs. state equivalent; adapt waiver language to all applicable jurisdictions