Online Claim Form

United States District Court for the Western District of Missouri

Melvin Lampton, Jr. v. Saint-Gobain Abrasives, Inc., No. 4:22-cv-00398

For use by retail purchasers of Norton bonded abrasive wheels for personal, family or household purposes (the “Covered Products”) between June 6, 2017, and February 1, 2024.

GENERAL INSTRUCTIONS

Settlement Class Members who seek payment from the settlement must complete and submit this Claim Form no later than 11:59 PM, Pacific Standard Time on April 17, 2024.

Before you complete and submit this Claim Form, you should read and be familiar with the settlement Agreement (the “Agreement”) and the Notice available at in the Case Documents section of this website. Defined terms (with initial capitals) used in these General Instructions have the same meaning as set forth in the settlement Agreement. By submitting this Claim Form, you acknowledge that you have read and understand the Notice, and you agree to the release of Released Claims included as a material term of the settlement Agreement.

If you fail to submit a timely and complete Claim Form, your claim may be rejected, and you may be precluded from any recovery from the Settlement Fund. If you are a member of the Settlement Class and you do not submit a valid and timely request to Opt-Out from the Settlement Class, you will be bound by any judgment entered by the Court approving the settlement regardless of whether you submit a Claim Form.

Claimant Information

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Contact Phone

Email Address

Name of Employer

Occupation

Attestation

SELECT AND COMPLETE ONLY ONE OPTION BELOW

Option 1Option 2

OPTION 1: No Proof of Purchase Required – If you choose to submit your Claim Form without proof of purchase, you may receive a payment of up to $3.00 per product for a maximum Benefit Amount of $15.00 per household (regardless of how many persons live in the household and regardless of whether the value of the total number of purchases of Covered Products exceeded $15.00).

Number of Covered Products purchased between June 6, 2017, and February 1, 2024.

Store location (address) or online site where Covered Product was purchased:	Part No. of Covered Product (See Exhibit A – Covered Products List)	Approximate date of purchase of Covered Product:	Approximate price paid for Covered Product:	Was the Covered Product used primarily for personal, family, or household purposes? (Y/N)
Store Address	Part No.	Date	Price	Yes or No *

OPTION 2: Proof of Purchase Required – If you choose to submit proof of your purchase, please include your documentation (an itemized receipt or credit card statement/electronic statement that sufficiently identifies the Covered Product(s) purchased and associated payment) with this Claim Form, when submitted. Eligible claimants who submit proof of purchase for one or more Covered Products may receive a payment equal to the total amount of such purchases up to a maximum Benefit Amount of $50.00 (regardless of whether the value of the total number of purchases of Covered Products exceeded $50.00).

Total Price of Covered Products purchased between June 6, 2017, and February 1, 2024:

Max: 15 files (must be less than 4MB each. PDF, JPEG, JPG, PNG allowed)

Payment Selection

Submission to Jurisdiction of the Court

By signing below, you are submitting to the jurisdiction of the United States District Court for the Western District of Missouri.

Certification under Penalty of Perjury

I hereby certify under penalty of perjury that:

I have read the Settlement Agreement and agree to its terms, including the release of the Released Claims against the Released Parties and Saint Gobain's denial of liability;
The information provided in this Claim Form is accurate and complete to the best of my knowledge, information, and belief;
I am a member of the Settlement Class and did not request to Opt-Out from the Settlement Class;
I am neither (a) an employee of Defendant; (b) a governmental entity; nor (c) a judicial officer to whom this Action is assigned, or any member of the judge’s immediate family;
I have not submitted any other Claim for the same purchases and have not authorized any other Person or entity to do so, and know of no other Person or entity having done so on my behalf;
I understand that by submitting this Claim Form, I am deemed to have given a complete release of all Released Claims against the Released Parties; and
I understand that Claim Forms will be audited for veracity, accuracy, and fraud. Incomplete and/or illegible Claim Forms can be rejected. If a Claim Form is determined not to be a valid claim, it will be rejected.

E-Signature

Date