Simmons et al. v. Apple Inc.

Case No. 17cv312251

Superior Court of the State of California, County of Santa Clara

If you received a personalized notice in the mail or via email with a Claim Identification Number and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Claim Identification Number exactly as it appears on your personalized Notice, (i.e. ABC12345678).

OR

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

You may download a claim form by clicking HERE.

Section I - Instructions

This Form must be submitted online or postmarked no later than November 20, 2020.

This Claim Form may be submitted in one of two ways:

  1. Electronically through this page.
  2. Mail to: Wireless Earphones Settlement Administrator, 1650 Arch St., Ste 2210, Philadelphia, PA 19103

To be effective as a claim under the proposed Settlement, this form must be completed, signed and sent, as outlined above, no later than November 20, 2020. If this Form is not postmarked or received by this date, you will remain a member of the Settlement Class, but will not receive any payment from the Settlement.

Due to the nature and scope of the information required to effectuate Direct Deposit (ACH) payments, if you wish to receive payment by Direct Deposit (ACH) you must submit a Claim using this website. All submitted Claims may be reviewed for accuracy and truthfulness, including through reference to information possessed by Apple.

Section II - Class Member Information

Claimant Name (Required):

Claimant Identification Number (Optional):

Current Contact Information

Your contact information will be used by the Settlement Administrator to contact you, if necessary, about your claim. Provision of your phone number is optional.

* Required Fields
Section III – Confirmation of Class Membership

(Required) Please confirm each statement as being true by adding your initials where noted. For data entry boxes, please enter the relevant information.

3. If you have Proof(s) of Purchase of the Powerbeats 2 earphones, please check the box indicating that you have Proof(s) of Purchase and provide the Proof(s) to the Settlement Administrator as instructed below. If you have a Proof(s) of Purchase for the Powerbeats 2 earphones, you may skip questions 4, 5 and 6. If you do not have any Proof of Purchase, you must answer questions 4, 5 and 6.

I have

4. The month and year of the purchase was as stated below:

+ Add Purchase

5. The store where I purchased the Powerbeats 2 earphones was:

6. The city and state in which the store where I purchased the Powerbeats 2 earphones was located were:

Section IV - Claiming Payment for a Warranty Repairs

Persons for whom Apple has a record of the Class Member obtaining a warranty repair or replacement on a Powerbeats 2 may be able to receive additional compensation. If you obtained or are obtaining a warranty repair or replacement on a Powerbeats 2 please confirm each statement as being true by adding your initials where noted. For data entry boxes, please enter the relevant information. To complete this section, you must provide the Apple ID associated with the warranty repair or replacement.

*To be a successive warranty repair or replacement, the second, or later, warranty repair or replacement must be on the device that was previously repaired or was provided to the customer as a replacement unit.

3. The Apple ID associated with warranty repair or replacement(s) is/are:

You may submit a Proof of Purchase or Proofs of Purchase to the Settlement Administrator in one of three ways.

  1. Electronically uploaded with your online claim.
  2. Via email to info@WirelessEarphonesSettlement.com. Please include your Claimant Identification Number or copy of your Claim Form with the Proof or Proofs.
  3. Mail to: Wireless Earphones Settlement Administrator, 1650 Arch St., Ste 2210, Philadelphia, PA 19103. Please include your Claimant Identification Number or copy of your Claim Form with the Proof or Proofs of Purchase.

Payment will be by PayPal or direct deposit (ACH), unless you request a paper check. You acknowledge that if you do not choose direct deposit (ACH) or PayPal, you may not receive payment as quickly and that the Settlement Administrator will not be responsible for Settlement checks that do not arrive by U.S. mail and may not reissue checks that are claimed as lost or stolen.

Identify your preferred method of payment if you are determined to be an eligible Settlement Class Member who filed a complete and accurate Claim Form:

Section V - Proof(s) of Purchase

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    Section VI – Additional Required Affirmations

    By completing this Claim Form, you are attesting, under penalty of perjury of the laws of the State of California, that the content in this Claim Form is true and correct to the best of your abilities.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@WirelessEarphonesSettlement.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    City
    State
    Zip Code
    Email Address
    Phone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@WirelessEarphonesSettlement.com

    Click here to edit your Claim.