Edit Claim

If you had previously submitted an online claim, you should have received a confirmation email with your Claim ID and Confirmation Code. If you would like to edit your claim please enter the codes you were provided below.

Please remember to enter the full Claim ID exactly as it appears in your confirmation email, (i.e. 12345678).

File Claim

Click below to complete a Claim Form.

The deadline for submitting this proof of claim form is

Please add the email, Confirmation@VSHandSanitizerSettlement.com, to your contact list to ensure that future correspondence is delivered to your inbox.

  1. You may submit your Claim Form by filling out the required information below and clicking the submit button or you may mail your completed claim by U.S. Mail to the following address: VS Hand Sanitizer Settlement Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA 19103. Please make sure to include the completed and signed Claim Form and all supporting documents in one envelope.
  2. Supporting Documentation: Submit photos of an itemized retail sales receipts or other document or retail store club or loyalty card record showing, at a minimum, the purchase of Hand Sanitizer Product, the purchase prices, and the date and place of purchase. Proof of purchase may be uploaded in Section V “Supporting Documents” below. *Class Members who do not submit Proof of Purchase are limited to 10 (ten) Automatic Payments.
  3. You must complete the entire Claim Form. Please type or write your responses legibly.
  4. Please keep a copy of your Claim Form and any supporting documents you submit. Do not submit your only copy of the supporting documents. Documentation submitted will not be returned. Copies of documentation submitted in support of your Claim should be clear and legible.
  5. If your Claim Form is incomplete or missing information, the Settlement Administrator may contact you for additional information. If you do not respond, the Settlement Administrator will be unable to process your claim, and you will waive your right to receive money under the Settlement.
  6. If you have any questions, please contact the Settlement Administrator by email at info@VSHandSanitizerSettlement.com, by phone at 1-866-875-6339, or by mail at the address listed above.
  7. You must notify the Settlement Administrator if your address changes. If you do not, you may not receive your payment.
  8. DEADLINE -- Your claim must be submitted online by August 12, 2023. Claim Forms submitted by mail must be mailed to the Settlement Administrator postmarked no later than August 12, 2023.
I. NAME AND CONTACT INFORMATION

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

* Required Fields

II. CLAIM TYPE

If you are claiming both Economic and Medical Monitoring Compensation, please select both options.

Class Members will receive an automatic payment based on the number of purchases each Class Member made for Hand Sanitizer Products. To receive an automatic payment, you must provide Proof of Purchase or sign the declaration below under penalty of perjury attesting to purchase and the number of bottles purchased.

All claimants making claims for medical monitoring compensation shall attest to use of the Hand Sanitizer Product and the need to medically monitor manifest dermal symptoms by signing the declaration below.

III. PURCHASE INFORMATION FOR ECONOMIC COMPENSATION
Number of Bottles Purchased Approximate Purchase Date Between January 1, 2015 and May 23, 2023
MM/YYYY		 Proof of Purchase?
(Yes / No)
+ Click Here to Add Additional Purchase Dates

*Class Members who do not submit Proof of Purchase, as described in the Claim Form Instructions above, are limited to 10 (ten) Automatic Payments.

DECLARATION: I declare under penalty of perjury of the laws of the United States that I have searched for but am unable to find documentary proof, but that I qualify for membership in the class.

IV. DECLARATION FOR MEDICAL MONITORING COMPENSATION

I declare under penalty of perjury of the laws of the United States that I am receiving medical care to monitor manifest dermal symptoms.

V. Supporting Documentation

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

    VI. Payment Method

    Please select one of the following payment options:

    You have successfully requested a payment. Click here if you would like to choose a different payment method.

    VII. VERIFICATION AND ATTESTATION UNDER PENALTY OF PERJURY

    By signing below and submitting this Claim Form, I hereby swear under penalty of perjury that I am the person identified above and the information provided in this Claim Form, including supporting documentation, is true and correct, and that nobody has submitted another claim in connection with this Settlement on my behalf.

    Your Claim Form has been submitted successfully.

    Please print this page for your records.

    Your Claim Details
    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
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    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@VSHandSanitizerSettlement.com

    Click here to edit your Claim.

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