Deloitte & Touche LLP     Deloitte & Touche LLP
Introduction  Claims Administration Documents Forms Notice FAQ Contact Us
Breast Implant Litigation Settlement > Forms  
Forms


  1. Ongoing Claim Form

  2. Supporting Medical Documentation Form

  3. Release of Dow Corning and the Released Parties

  4. Solicitor's Certificate of Legal Advice

  5. Affidavit of Unrepresented Settlement Class Member

  6. Change of Address Form

  7. Change of Legal Representative Form

  8. Claimant's Checklist

  9. Registration/Opt-In Form



Adobe Acrobat is required to view the forms. To download Adobe Acrobat, click here.

All completed forms and supporting documentation for Expedited, Raw Material and Current Claims (including Rupture Claims) should now have been submitted to the Claims Facility. Ongoing Claimants are required to submit all documentation by the Final Claims Deadline of June 1, 2009.

All faxes should be sent to:
1-866-732-9160. Documents requiring signature must be sent by mail to the Claims Facility
  Security | Legal | Privacy    

Copyright ©2004 by Deloitte Touche Tohmatsu. All rights reserved.
Deloitte Touche Tohmatsu is a Swiss Verein (association), and, as such, neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names "Deloitte," "Deloitte & Touche," "Deloitte Touche Tohmatsu," or other related names. The services described herein are provided by the member firms and not by the Deloitte Touche Tohmatsu Verein. Not all services are provided by all member firms.