---
name: class-action-claim-form
title: Class Action Claim Form
description: Drafts official class action claim forms balancing plain-language accessibility with FRCP 23 enforceability. Trigger when creating settlement claim forms, proof-of-claim documents, or class member claim submissions.
author: CaseMark
author_url: https://github.com/CaseMark/skills/tree/main/skills/legal/class-action-claim-form
license: Apache-2.0
version: 0.1.0
execution_mode: open
jurisdiction: us
practice: litigation
language: en
tags: [drafting, pleading]
---

# Class Action Claim Form

Draft an enforceable claim form enabling lay claimants to submit settlement claims while satisfying FRCP 23, court orders, and the settlement agreement.

## Prerequisites

Gather before drafting:

1. **Settlement agreement** — approved or pending, with class definition, claim categories, compensation structure
2. **Court orders** — preliminary/final approval with any form-specific requirements
3. **Class definition** — precise membership criteria (dates, transactions, geography)
4. **Administrator details** — name, address, email, phone, website
5. **Release scope** — released parties, released claims, statutory waiver requirements

## Quick Start

1. Confirm jurisdiction (FRCP 23 vs. state equivalent) and adapt statutory language accordingly
2. Draft each section below in order
3. Write at 8th-grade reading level — short sentences, active voice, defined terms
4. Do not simplify release or certification language to the point of unenforceability
5. Run the checks in Pitfalls before finalizing

## Form Sections

### 1. Header & Case Identification

- Title: "OFFICIAL CLAIM FORM" — bold, prominent
- Full case caption, court name, docket number
- Administrator contact (mail, email, phone, website)
- **Deadline**: bold, specific date/time with timezone; state postmark vs. receipt rule
- Intro paragraph: plain-language eligibility summary, reference to settlement agreement date and approval order

### 2. Claimant Information

Structured fields:

- Full legal name (as during class period), current name if different
- Current address, email, phone, alternative contact
- **Class-specific identifiers**: purchase dates, account numbers, employment periods — explain why each is needed
- **Special claimants** (if applicable): deceased (executor + authority docs), minors/incapacitated (guardian + docs), entities (name + authorized rep)
- Privacy disclosure: how personal information will be used and protected

### 3. Claim Details & Documentation

Per claim category from the settlement:

- Checkbox, category description, applicable date range
- Fields for amount/damages, reference number, description of harm

Documentation tiers:

| Claim Amount | Required | Acceptable Forms |
|---|---|---|
| Under threshold | Declaration only | N/A |
| Above threshold | Submit with form | Receipts, statements, contracts, correspondence |

Specify copies acceptable (not originals). Include false-information warning (claim denial, civil penalties, criminal prosecution).

### 4. Certification & Release

**Certification** — under penalty of perjury, claimant affirms:

- Information is true, accurate, and complete
- Claimant meets the class definition
- Claims not previously released; no prior compensation received
- Bound by settlement terms and court orders

**Release** (separate section, own acknowledgment checkbox):

- List all released parties (defendants, affiliates, officers, directors, agents, successors)
- Describe released claims — enforceable specificity, lay-reader clarity
- Include statutory waiver for unknown claims where applicable (e.g., Cal. Civ. Code § 1542 — verify jurisdiction)
- State consequences: bound by settlement/judgment, waive separate suit, bound by appeals

### 5. Signature Block

- Signature line, date, printed name
- Title/relationship field for representatives
- Note electronic signatures acceptable if e-filing permitted
- Representatives must state authority and relationship

### 6. Submission Instructions

| Method | Details |
|---|---|
| Mail | Full address; postmark by deadline |
| Email | Address; received by deadline with timezone |
| Online | URL; uploaded by deadline with timezone |

Include: receipt confirmation process, what to do if no confirmation within stated business days, post-submission timeline (review, notification, challenge process).

Remind claimant: **retain copies of form and all supporting documentation**.

## Pitfalls & Checks

- **Required disclaimers**: (1) submission does not guarantee payment; (2) settlement subject to court approval; (3) attorney fees/costs deducted as applicable
- **Accessibility**: screen-reader compatible; note if translations required for the class
- **Page formatting**: number all pages; case name/number in header/footer; if >2 pages, add first-page checklist
- **No legal advice**: form must not constitute or appear to constitute legal advice
- **Jurisdiction**: confirm FRCP 23 vs. state equivalent; adapt waiver language to all applicable jurisdictions