Coppertone Mineral-Based Sunscreen Settlement Claim Form


CLAIM FORM INSTRUCTIONS

In order for you to receive a cash payment of up to $10.00 or more from the settlement of the class action lawsuit concerning Coppertone “Mineral-Based” Sunscreen Products, titled Prescott v. Bayer HealthCare LLC, you must complete and submit a Claim Form, as described below.

REQUIREMENTS FOR SUBMITTING A CLAIM FORM

Your claim will only be considered if you comply with all of the following:

  1. Complete Claim Form

    You must accurately complete all portions of the Claim Form. Please complete only one Claim Form per household (i.e. per address), regardless of the number of qualifying Coppertone “Mineral-Based” products you purchased. Please include with the Claim Form any proof of purchase you may have.

  2. Signature

    You must sign the Claim Form.

  3. Online/Mail Submission

    In order for you to receive a cash payment, you must submit a completed Claim Form and any proof of purchase you have either online below or by First Class U.S. Mail to the following postal box:

    Digital Settlement Group, LLC
    P.O. Box 166
    Valparaiso, IN 46384

  4. Deadline

    Your failure to complete and submit the Claim Form by November 17, 2021, will preclude you from receiving any payment in this settlement. Please note that the Claim Form and any proof of purchase must be postmarked via mail or submitted online on or before this date to be valid.

A. CLAIMANT INFORMATION

Indicates Required Field


B. QUALIFYING PRODUCTS, PROOF OF PURCHASE, AND ADJUSTMENTS

Qualifying Products: To qualify for a cash payment, you must have purchased one or more of the following Coppertone sunscreen products with a “Mineral Based” label in various sizes and forms: (1) Coppertone Water Babies Pure & Simple; (2) Coppertone Kids Tear Free; or (3) Coppertone Sport Face. Additionally, you must have made the purchase prior to September 17, 2021. in the United States, and the purchase cannot have been for wholesale, resale, or distribution. Purchased products that satisfy these conditions are “Products” or “Qualifying Products.” You may only submit a claim for Qualifying Products.

Proof of Purchase: You may make a claim to receive $2.50 for each Qualifying Product if you submit proof of purchase. There is no limit on the number of claims you may submit, so long as you submit proof of purchase for Qualifying Products with those claims.

Proof of purchase means a receipt or other reasonably reliable documentation that establishes purchase of the Qualifying Products. Proof of purchase, for example, may be in the form of an itemized store receipt, loyalty/membership card printouts, non-identical original UPC codes, or pictures of non-identical UPC codes for each Qualifying Product purchased.

No Proof of Purchase: You may make a claim to receive $2.50 for each Qualifying Product, without any proof of purchase, for up to four (4) Qualifying Products (for up to $10.00).

Adjustments: The Claim Administrator may adjust your cash payment upwards (not to exceed a multiplier of nine (9)) or downwards, on a pro-rata basis, per Qualifying Product, if the total amount of claims exceeds, or fails to exceed, the available settlement funds. Payments will be issued after the Effective Date, if the Court approves the settlement.


C. PAYMENT OPTIONS

Please select the method you wish to receive payment and provide all requested information necessary to process payment.


D. DECLARATION OF PURCHASE

I made the following purchases of the Qualifying Products, in the United States, on or before September 17, 2021. These purchases were not for the purpose of resale. I would not have made these purchases if the product labels did not include the phrase “Mineral-Based.”

I certify under penalty of perjury under the laws of the United States that all of the foregoing is true and correct.