Hino Settlement Claims Form - Oxford Recovery Partners

Only vehicles owned or leased on or before October 30th 2023 are valid for settlement.

Truck #1

Did you purchase or lease this truck?

Purchase

Lease

Did you buy this truck new or used?

New

Used

Do you still own this truck?

Yes

Have you owned this truck for at least 6 months?

Yes

Click this button to copy the options above to all trucks

Claim Information

First Name

Last Name

Job Title (if the vehicles were owned or leased by a company)

Company Name (if the vehicles were owned or leased by a company)

Phone

Address Line 1

Address Line 2

City

State

Zip

Summary

Claimant

Claimant Address

Submitted Trucks

Truck #1

Leased Used No Longer Owned Owned for less than 6 months

Claim Information

Contact Information

Authorization

We need a signature

I certify that all the information that I supplied in this Claim Form is true and correct to the best of my knowledge and belief. I understand that the information I submit in this Claim Form is subject to verification and the Settlement Administrator may reach out to me for further information or documentation to verify my Claim.

Signature of Primary Owner/Lessee

11/16/2024

Draw in the box above

Printed First Name

Printed Last Name

Hino Emissions

$1,500 - $15,000 Estimated Payment Per Vehicle

Claim Deadline: June 17th

Truck #1

Claim Information

Summary

Submitted Trucks

Authorization

We need a signature