Bacca et al. v. BMW of North America, LLC

							    MUST BE
 POSTMARKED OR
SUBMITTED ONLINE
 NO LATER THAN
SEPTEMBER 2, 2010*


          Bacca et al. v. BMW of North America, LLC, Case No. 06-06753 DDP (AJWx)
                  (United States District Court, Central District of California)

                                      CLAIM STATEMENT

  To make a claim in the class action settlement in the above case, please complete and
  mail this form, postmarked no later than September 2, 2010*, to:

                                     Claims Administrator
                                       Gilardi & Co. LLC
                                       P.O. Box 808054
                                   Petaluma, CA 94975-8054

  Alternatively, you may submit your claim by e-mailing it to
  claims@E46subframeclassactionsettlement.com no later than midnight
  on September 2, 2010*.

  A.      CURRENT PERSONAL INFORMATION

  Name:

  Address:



  City, State, ZIP Code:

  Telephone Number:


  B.      PERSONAL INFORMATION AT TIME OF REPAIR (if applicable)

  Name:

  Address:



  City, State, ZIP Code:

  Telephone Number:




  * The deadline to submit a claim may be extended. For updates, please check the website at
  www.E46subframeclassactionsettlement.com
C.        INFORMATION ON CLASS VEHICLE

Model & Model Year:

Vehicle Identification Number:

Bought:                    New           Used

Modification(s) Made
To Vehicle




Name of Dealer Where
Vehicle Is Typically Serviced:
(if applicable)

Address:



City, State, ZIP Code:

Telephone Number:


D.        INFORMATION ON REPAIR OF SUB-FRAME

Name of Business Where
Repair Was Performed:

Address:



City, State, ZIP Code:

Telephone Number:

Date of Repair:

Total Cost of Repair:            $
E.      REQUIRED DOCUMENTATION

You must attach or enclose:

Proof of repair expenditure. For this requirement, you must provide documentation that the sub-
frame repair was performed and that you paid the repair cost you specified above. Acceptable
documentation includes an original detailed repair invoice that is marked “Paid” and reflects a
sub-frame repair or a receipt showing payment and that the payment was for sub-frame repairs.
Please be sure to keep copies for your records of all documents submitted with your claim.

If a repair invoice is not available, you may submit (i) a sworn written written statement from the
business stating that it performed the sub-frame repair and that the sub-frame repair invoice or
other contemporaneous documentation of the sub-frame repair is unavailable; and (ii) proof that
you paid the amount you specified above, such as a credit card statement or a cancelled check.


F.      CERTIFICATION

I declare under penalty of perjury that the foregoing is true and correct to the best of my
knowledge and belief.



                                                                       /              /       ______
Signature                                                  Date