Why did you claim the amount you did?
Please include the requested documents related to the type of claim you are filing. Be advised that the CMVRC may require reasonable additional information
to process eligible claims.
Click the "Browse" or “Choose File” button and select the relevant file from your computer. The selected files will be uploaded
when the "Agree and Submit" button is clicked.
Required documentation may be uploaded in .jpg,.jpeg,.tif,.tiff,.gif,.png,.pdf format only.
You may upload up to 10 files.
Total upload size can not be larger than 10 MB.
If there are problems uploading, please inquire via mail or email.
P.O. Box 8060
San Rafael, CA 94901-8060
You must notify the CMVRC of any changes or updates to the information contained in your claim form, including notice of any payments you have received from your insurance company,
the dealer, the dealer’s bond, or any other person or entity. If you fail to notify the CMVRC of any changes or updates, the CMVRC may deny your claim. You agree to repay to the CMVRC
to the extent you receive any money from anyone for the loss covered by CMVRC’s payment to you.
The CMVRC may contact the Dealer/Lessor-Retailer, the Department of Motor Vehicles, a financial institution or others to get information about your claim.
By submitting this Claim Form, you authorize the CMVRC to request and obtain information to determine whether your claim is eligible for payment. You authorize the Dealer/Lessor-Retailer
that is the subject of this claim, the Department of Motor Vehicles, lessors, financial institutions, and other persons to cooperate with the CMVRC and to release to the CMVRC any
record(s) or other information that the CMVRC in its discretion may request to determine whether your claim is eligible for payment.
By submitting this claim, you acknowledge that you hold the [Settlement Administrator/Claims Administrator (as defined in court docs)] harmless from any and all losses, claims,
liabilities, damages, or suits arising out of or in connection with the issuance of any distribution payment in this matter, including those resulting from the submission of incorrect
contact information or fraud.