Prior Reimbursement. If you previously received any payment or reimbursement in connection with the Qualifying Theft or Qualifying Theft Attempt, you must provide documentation of this with your Claim Form (for example, Insurance Records or prior campaign reimbursement and/or customer satisfaction payments). XXXXX Claims can be subm#it:t6ed9e6le4ctronically at “Insurance Records” refers to documents issued by the car insurance company reflecting that coverage was denied or a final insurance settlement that shows how much the insurance paid minus the deductible. ☐ I OWN A CLASS VEHICLE NOT ELIGIBLE FOR THE SOFTWARE UPGRADE AND I AM REQUESTING REIMBURSEMENT FOR THE QUALIFYING PURCHASE OF A STEERING WHEEL LOCK AND/OR A GLASS BREAKAGE ALARM OR SIMILAR ANTI‐THEFT SYSTEM, OR ANOTHER AFTERMARKET MODIFICATION DESIGNED TO DETER OR PREVENT THEFT FOR MY CLASS VEHICLE. Note: This Settlement benefit is only available if your Class Vehicle is ineligible for the Software Upgrade. Reimbursement under this category is capped at $300 per Class Vehicle if you are not reimbursed for the purchase of a steering wheel lock and capped at $250 if you are reimbursed for the purchase of a steering wheel lock, regardless of whether your out‐of‐pocket losses exceed these cap amounts. Claims for this benefit must be submitted no later than XXXX. [A] Provide the total amount for which you are requesting reimbursement: $ . [B] Provide the following to assist with processing your claim: ANTI‐THEFT SYSTEM DESCRIPTION(S) (STEERING WHEEL LOCK, ALARM KIT, ETC. (List all that apply)) Date of purchase of steering wheel lock: ‐ ‐ MM DD YYYY Cost of Steering Wheel Lock: Date of purchase of anti‐theft system: ‐ ‐ MM DD YYYY Cost of purchase of anti‐theft system: Date of installation of anti‐theft system: ‐ ‐ MM DD YYYY Cost of installation of anti‐theft system: [C] Did you already receive a steering wheel lock provided by Hyundai or Kia (for example, shipped directly from Hyundai or Kia, from a dealership, or through a law enforcement department) when you purchased a steering wheel lock (if applicable)? Check the appropriate box below: ☐ Yes OR ☐ No [B] Required Documentation:
Prior Reimbursement. If you previously received any payment or reimbursement in connection with the
Prior Reimbursement. If you previously received any payment or reimbursement in connection with the Qualifying Theft or Qualifying Theft Attempt, you must provide documentation of this with your Claim Form (for example, Insurance Records or prior campaign reimbursement and/or customer satisfaction payments). “Insurance Records” refers to documents issued by the car insurance company reflecting that coverage was denied or a final insurance settlement that shows how much the insurance paid minus the deductible.
Prior Reimbursement. If you previously received any payment or reimbursement in connection with the Qualifying Theft or Qualifying Theft Attempt, you must provide documentation of this with your Claim Form (for example, Insurance Records or prior campaign reimbursement and/or customer satisfaction payments). “Insurance Records” refers to documents issued by the car insurance company reflecting that coverage was denied or a final insurance settlement that shows how much the insurance paid minus the deductible. If you are requesting reimbursement for more than one Qualifying Theft or Qualifying Theft Attempt, you must complete a separate claim form for each incident and provide the information requested. ☐ I AM REQUESTING REIMBURSEMENT FOR DAMAGE TO MY CLASS VEHICLE AND/OR DAMAGED OR LOST PERSONAL PROPERTY DUE TO A QUALIFYING THEFT OR QUALIFYING THEFT ATTEMPT. Note: Reimbursement under this category is capped at $3,375 per occurrence, regardless of whether your out‐of‐pocket losses exceed this. Claims for this benefit must be submitted no later than XXXX. [A] Provide the total amount for which you are requesting reimbursement: $ .
Prior Reimbursement. If you previously received any payment or reimbursement in connection with the Qualifying Theft or Qualifying Theft Attempt, you must provide documentation of this with your Claim Form (for example, Insurance Records or prior campaign reimbursement and/or customer satisfaction payments).
Prior Reimbursement. If you previously received any payment or reimbursement in connection with the Qualifying Theft or Qualifying Theft Attempt, you must provide documentation of this with your Claim Form (for example, Insurance Records or prior campaign reimbursement and/or customer satisfaction payments). “Insurance Records” refers to documents issued by the car insurance company reflecting that coverage was denied or a final insurance settlement that shows how much the insurance paid minus the deductible. [4] SIGN AND DATE The information on this form is true and correct to the best of my knowledge. I agree to participate in the Settlement. I authorize any dealership that serviced my vehicle to release records to the Settlement Administrator as needed to assist in the payment of my Claim. To the extent I am seeking reimbursement for a Qualifying Loss for which I do not have documentation, I attest as follows:
