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BOSCH SETTLEMENT CLAIM FORM

CLAIMANT INFORMATION

Please fill in the below contact information. This information will only be used to contact you regarding the Bosch Settlement.First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

INTRODUCTION

IMPORTANT: IF YOU FILED (OR WILL FILE) A CLAIM IN ONE OR BOTH OF THE 2.0-LITER OR 3.0-LITER VOLKSWAGEN SETTLEMENTS, AND THE CLAIM IS APPROVED, YOU ARE AUTOMATICALLY AN ELIGIBLE CLASS MEMBER IN THE BOSCH SETTLEMENT AND WILL RECEIVE PAYMENT IF YOU DO NOT OPT OUT OF THE BOSCH SETTLEMENT. IF THIS DESCRIBES YOUR SITUATION, YOU DO NOT NEED TO FILE A CLAIM IN THE BOSCH SETTLEMENT.

If you are the registered owner of more than one potentially Eligible Vehicle, you must submit a separate Claim Form for each vehicle.

To file your Claim in the Bosch Settlement, you may:

(1) Submit a Claim online by visiting www.BoschVWSettlement.com. Online Claim submission will result in expedited processing of your Claim.

(2) File a paper Claim by completing this form and returning it along with any required documentation on or before December 31, 2019, (unless you are an Eligible Seller and missed the identification deadline in the 2.0-liter Volkswagen (VW) Settlement, or if you are an Eligible Former Owner and do not file a Claim in the 3.0-liter Volkswagen (VW) Settlement, in which case you must have begun your Claim submission process by registering online at www.BoschVWSettlement.com, on or before May 1, 2017; or unless you opted out of either or both of the Volkswagen (VW) Settlements, in which case this form and any required documentation must be returned on or before August 15, 2017) by mail, postmarked by the deadline that is relevant to your Claim, to:

Bosch SettlementClaims Administrator

P.O. Box 5110Portland, OR 97208-5110

Or by fax to:

Fax: 1-844-760-8029

Note: If submitting by fax, keep a copy of the fax confirmation.

Incomplete submissions will not be processed.

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BOSCH SETTLEMENT CLAIM FORM

IMPORTANT: BEFORE COMPLETING THIS CLAIM FORM, READ THIS ENTIRE FORM AND THE LONG FORM NOTICE CAREFULLY. THE LONG FORM NOTICE CONTAINS ADDITIONAL INFORMATION REGARDING YOUR ELIGIBILITY FOR SETTLEMENT BENEFITS AND OTHER IMPORTANT INFORMATION.

You may have already received a copy of the Long Form Notice in the mail. If you do not have a copy of the Long Form Notice, you can download a copy online at www.BoschVWSettlement.com/en/Home/Documents or request a copy be mailed to you by calling toll-free 1-844-305-1928.

If there is more than one registered owner or lessee for a potentially Eligible Vehicle, any required information and documentation must be submitted for each registered owner or lessee.

If you would like to submit a Claim online, please visit www.BoschVWSettlement.com. Please note: this is not a Claim under either of the 2.0-liter or 3.0-liter VW Settlements. To file a Claim under those Settlements, you must visit www.VWCourtSettlement.com.

INSTRUCTIONS

**If you need help completing this form, please visit www.BoschVWSettlement.com or call toll-free 1-844-305-1928.**

(1) If you have submitted a Claim online via the online Claims portal at www.BoschVWSettlement.com, you do not need to fill out this form.

(2) If you would prefer to submit your Claim online, please visit the online Claims portal at www.BoschVWSettlement.com.

(3) You do not need to fill out every page of this form. You only need to fill out certain portions, as outlined in the box on the next page.

(4) Please submit every page of this form (even if blank). Submitting all pages will result in faster processing of your Claim.

(5) You must submit the required documentation shown in Steps 4, 5, 6, or 7, depending on your eligibility status. We will contact you if your Claim or documents are incomplete.

(6) You must sign where indicated in Step 9 for your Claim to be processed.

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BOSCH SETTLEMENT CLAIM FORM

ELIGIBILITY

To determine which sections of the form you need to complete, see below.

Eligible Owner:• If you are the registered owner of the vehicle, complete Steps 1, 2, 3, 4, and 9.• If you totaled and transferred to an insurance company your 2.0-liter vehicle after September 16, 2016, or

your 3.0-liter vehicle after January 31, 2017, complete Steps 1, 2, 3, 5, and 9.

Eligible Current Lessee:• If you currently lease the vehicle from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial

Services, or Porsche Financial Services, Inc., complete Steps 1, 2, 3, 6, and 9.• If you formerly leased the vehicle from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial

Services, or Porsche Financial Services, Inc. and purchased the vehicle at the end of the lease, complete Steps 1, 2, 3, 4, and 9.

Eligible Former Lessee:• If you formerly leased the vehicle from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial

Services, or Porsche Financial Services, Inc., but returned the vehicle at the end of the lease term, complete Steps 1, 2, 3, 7, and 9.

Eligible Seller/Eligible Former Owner:• If you owned the 2.0-liter vehicle as of September 18, 2015, but sold or otherwise transferred ownership

before June 28, 2016; or the 3.0-liter vehicle as of September 18, 2015, and/or November 2, 2015, but sold or otherwise transferred ownership before January 31, 2017, complete Steps 1, 2, 3, 8, and 9.

• If you totaled and transferred to an insurance company your 2.0-liter vehicle on or after September 18, 2015, but before June 28, 2016, or if you totaled and transferred to an insurance company your 3.0-liter vehicle on or after September 18, 2015, but before January 31, 2017, complete Steps 1, 2, 3, 8 and 9.

If you believe you may be eligible to claim benefits under the Settlements but do not fit into any of the categories above, or if you have any questions about which sections you need to complete, please visit www.BoschVWSettlement.com or call toll-free 1-844-305-1928.

STEP 1: VEHICLE MODEL AND MODEL YEAR

Check the box next to your vehicle model and model year. Check only one box in each column.

If you are the registered owner of more than one potentially Eligible Vehicle, you must submit a separate Claim Form for each vehicle.

VOLKSWAGEN ELIGIBLE VEHICLES LIST

MODEL MODEL YEAR

2.0-liter Beetle 2013 2014 2015

2.0-liter Beetle Convertible 2013 2014 2015

2.0-liter Golf 2010 2011 2012

2013 2014 2015

2.0-liter Golf SportWagen 2015

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BOSCH SETTLEMENT CLAIM FORM

VOLKSWAGEN ELIGIBLE VEHICLES LIST (CONTINUED)

MODEL MODEL YEAR

2.0-liter Jetta

2009 2010 2011

2012 2013 2014

2015

2.0-liter Jetta SportWagen2009 2010 2011

2012 2013 2014

2.0-liter Passat2012 2013 2014

2015

3.0-liter Touareg

2009 2010 2011

2012 2013 2014

2015 2016

AUDI ELIGIBLE VEHICLES LIST

MODEL MODEL YEAR

2.0-liter A32010 2011 2012

2013 2015

3.0-liter Q7

2009 2010 2011

2012 2013 2014

2015

3.0-liter A6 2014 2015 2016

3.0-liter A7 2014 2015 2016

3.0-liter A8, A8L 2014 2015 2016

3.0-liter Q5 2014 2015 2016

PORSCHE ELIGIBLE VEHICLES LIST

MODEL MODEL YEAR

3.0-liter Cayenne Diesel2013 2014 2015

2016

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BOSCH SETTLEMENT CLAIM FORM

STEP 2: INDIVIDUAL INFORMATION

Please complete the following information for the registered owner(s), current lessee(s), Eligible Seller/Former Owner(s), or Former Lessee(s) of the potentially Eligible Vehicle. If the potentially Eligible Vehicle has multiple registered owners or lessees, please provide information for additional owners or lessees below and, if necessary, on a separate sheet. Please use each individual’s full legal name.

INDIVIDUAL INFORMATION

The vehicle is registered to (check one):

Private Owner(s)

Business Organization

Trust

Business Organization/Trust Name(s) (if applicable)

First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

Would you like to receive updates sent to this email address concerning the status of the Settlements, including the status of any Claim filed after final approval of the Settlements by the Court, and notifications of any actions you are required to take to pursue a Claim? (Select one.):

(If you select “Yes,” you will receive status notifications by email but you will be required to register online with your Claim number and VIN to obtain details about your Claim on the online Claims portal. If you select “No”, you will receive status updates about your Claim by mail. You may also call the Bosch Settlement Claims Administrator at 1-844-305-1928 to obtain all status updates.)

Yes

No

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BOSCH SETTLEMENT CLAIM FORM

ADDITIONAL REGISTERED OWNER OR LESSEE

Only fill in the below if applicable.

First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

THIRD-PARTY AUTHORIZATION

Only fill in the below if you are filing this form on behalf of the registered owner(s).

First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

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BOSCH SETTLEMENT CLAIM FORM

REGISTERED ADDRESS

Please provide the address that matches the registration for the potentially Eligible Vehicle. If your address is different than the vehicle’s registered address or you no longer own or lease the vehicle, fill out the mailing address in the “Mailing Address” section.

First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

MAILING ADDRESS

Complete this section only if your mailing address differs from the registered address supplied in the “Registered Address” section.

First Name MI Last Name

Address 1

Address 2

City State ZIP

Country Phone– –

Email

ADDITIONAL INFORMATION

Please answer the questions below and sign below. Each registered owner or lessee listed above must complete and sign this section.

Have you and/or your co-registrant previously submitted a Claim in either of the 2.0-liter or 3.0-liter Volkswagen (VW) Settlements?

Yes

No

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BOSCH SETTLEMENT CLAIM FORM

If you answered “Yes,” above, please answer the below questions.If you answered “No,” above, please proceed to Step 3.

As of the date you are completing this Claim, has your previously submitted 2.0-liter or 3.0-liter Volkswagen (VW) Settlement Claim been approved?

Yes

No

As of the date you are completing this Claim, has your previously submitted 2.0-liter or 3.0-liter Volkswagen (VW) Settlement Claim been denied?

Yes

No

Please provide your 2.0-liter Volkswagen (VW) Settlement Claim Number (if applicable)

Please provide your 3.0-liter Volkswagen (VW) Settlement Claim Number (if applicable)

Are the names of the registered owner(s) or lessee(s) listed in Step 2 different from the name(s) on the title for the vehicle? (If you are a lessee, you may skip this question.)

Yes

No

Are you or any other individual or entity listed on this form a Volkswagen officer, director, employee or participant in Volkswagen’s internal lease program; an officer, director or employee of a Volkswagen affiliate; an officer, director or employee of a Volkswagen distributor; an authorized Volkswagen, Porsche or Audi dealer; an officer or director of an authorized Volkswagen, Porsche or Audi dealer; an officer, director or employee of Robert Bosch GmbH or Robert Bosch LLC; an officer, director or employee of an affiliate of Robert Bosch GmbH or Robert Bosch LLC; an officer, director or employee of Volkswagen AG, Volkswagen Group of America, Inc., Volkswagen Group of America Chattanooga Operations, LLC, VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi AG, Audi of America LLC, Dr. Ing h.c. F. Porsche AG and/or Porsche Cars North America, Inc.; an officer, director or employee of an affiliate of Volkswagen; or a Volkswagen-branded franchise dealer that operated in the United States or its territories as of or at any time since September 18, 2015 (for 2.0-liter vehicles), or November 2, 2015 (for 3.0-liter vehicles)?

Yes

No

Are you or any other individual listed on this form a judicial officer or associated Court staff assigned to this case, or an immediate family member thereof?

Yes

No

Are you filing a Claim on behalf of a decedent’s estate? If you answer “Yes” to this question, you may be subject to additional documentation requirements, as listed below.

Yes

No

By checking this box and signing this form, I certify that the above answers are true and accurate to the best of my knowledge.

Print Name:

Signature: Date: – –MM DD YY

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BOSCH SETTLEMENT CLAIM FORM

ADDITIONAL INFORMATION (CONTINUED)

Additional registered owner or lessee (if applicable)

Have you and/or your co-registrant previously submitted a Claim in either of the 2.0-liter or 3.0-liter Volkswagen (VW) Settlements?

Yes

No

If you answered yes above, please answer the below questions.

As of the date you are completing this Claim, has your previously submitted 2.0-liter or 3.0-liter Volkswagen (VW) Settlement Claim been approved?

Yes

No

As of the date you are completing this Claim, has your previously submitted 2.0-liter or 3.0-liter Volkswagen (VW) Settlement Claim been denied?

Yes

No

Please provide your 2.0-liter Volkswagen (VW) Settlement Claim Number (if applicable)

Please provide your 3.0-liter Volkswagen (VW) Settlement Claim Number (if applicable)

Are the names of the registered owner(s) or lessee(s) listed in Step 2 different from the name(s) on the title for the vehicle? (If you are a lessee, you may skip this question.)

Yes

No

Are you or any other individual or entity listed on this form a Volkswagen officer, director, employee or participant in Volkswagen’s internal lease program; an officer, director or employee of a Volkswagen affiliate; an officer, director or employee of a Volkswagen distributor; an authorized Volkswagen, Porsche or Audi dealer; an officer or director of an authorized Volkswagen, Porsche or Audi dealer; an officer, director or employee of Robert Bosch GmbH or Robert Bosch LLC; an officer, director or employee of an affiliate of Robert Bosch GmbH or Robert Bosch LLC; an officer, director or employee of Volkswagen AG, Volkswagen Group of America, Inc., Volkswagen Group of America Chattanooga Operations, LLC, VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi AG, Audi of America LLC, Dr. Ing h.c. F. Porsche AG and/or Porsche Cars North America, Inc.; an officer, director or employee of an affiliate of Volkswagen; or a Volkswagen-branded franchise dealer that operated in the United States or its territories as of or at any time since September 18, 2015 (for 2.0-liter vehicles), or November 2, 2015 (for 3.0-liter vehicles)?

Yes

No

Are you or any other individual listed on this form a judicial officer or associated Court staff assigned to this case, or an immediate family member thereof?

Yes

No

Are you filing a Claim on behalf of a decedent’s estate? If you answer “Yes” to this question, you may be subject to additional documentation requirements, as listed below.

Yes

No

By checking this box and signing this form, I certify that the above answers are true and accurate to the best of my knowledge.

Print Name:

Signature: Date: – –MM DD YY

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BOSCH SETTLEMENT CLAIM FORM

STEP 3: VEHICLE INFORMATION

Please provide all 17 characters of the Eligible Vehicle’s Vehicle Identification Number (VIN).

VEHICLE IDENTIFICATION NUMBER (VIN)

The VIN can be found on the dashboard of the vehicle and is 17 characters long. To confirm whether or not your vehicle is eligible for participation the Bosch Settlement, please visit www.BoschVWSettlement.com.

Vehicle Identification Number (VIN)

ADDITIONAL VEHICLE INFORMATION

If you are the registered owner or you currently lease the vehicle, please fill in the information below. If you are not the registered owner or you no longer lease the vehicle, please proceed to Step 4.

Did your vehicle have a Branded Title of Assembled, Dismantled, Flood, Junk, Rebuilt, Reconstructed, or Salvage on September 18, 2015? (Select one.)

Yes

No

Was your vehicle acquired by any person or entity from a junkyard or salvage yard after September 18, 2015? (Select one.)

Yes

No

Can your vehicle be driven under its own 2.0-liter or 3.0-liter engine power? (Select one.)Yes

No

To determine the next sections of the form that you should complete, please see below. If you have questions about the section that you need to complete, please visit www.BoschVWSettlement.com or call toll-free 1-844-305-1928.

• If you are the registered owner of the vehicle identified in Step 3, fill out Step 4 and then skip to Step 9.• If you totaled and transferred to an insurance company the 2.0-liter vehicle identified in Step 3 after September

16, 2016, or the 3.0-liter vehicle identified in Step 3 after January 31, 2017, fill out Step 5 and then skip to Step 9.• If you currently lease the vehicle identified in Step 3, fill out Step 6 and then skip to Step 9.• If you formerly leased the vehicle identified in Step 3 and purchased the vehicle at the end of the lease, fill out

Step 4 and then skip to Step 9.• If you formerly leased the vehicle identified in Step 3 but returned the vehicle at the end of the lease term, fill

out Step 7 and then skip to Step 9.• If you owned the 2.0-liter vehicle identified in Step 3 as of September 18, 2015, but sold or otherwise transferred

ownership before June 28, 2016, fill out Step 8 and then Step 9.• If you owned the 3.0-liter vehicle identified in Step 3 as of September 18, 2015, and/or November 2, 2015, but

sold or otherwise transferred ownership before January 31, 2017, fill out Step 8 and then Step 9.• If you totaled and transferred to an insurance company the 2.0-liter vehicle identified in Step 3 on or after

September 18, 2015, and before June 28, 2016, fill out Step 8 and then Step 9.• If you totaled and transferred to an insurance company the 3.0-liter vehicle identified in Step 3 on or after

September 18, 2015, and before January 31, 2017, fill out Step 8 and then Step 9.

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BOSCH SETTLEMENT CLAIM FORM

STEP 4: CURRENT OWNER INFORMATION

OWNERSHIP INFORMATION

If you are the registered owner of the vehicle identified in Step 3, please fill out the information below. If you are not the registered owner of the vehicle, please skip to Step 5.

Please enter the date that you purchased the vehicle: (Documentation will be required.)

– –MM DD YY

Did you purchase this vehicle at the end of a lease from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services? (Select one.)

Yes

No

REQUIRED DOCUMENTATION: CURRENT OWNER

If you are or were the registered owner of your vehicle, you must submit a copy of each of the following types of documentation with your Claim Form.

• Current and valid government-issued photo identification (front and back) of each registered owner named in Step 2.• If the vehicle was registered to a corporate entity or a trust, a current and valid government-issued photo

identification (front and back) of the individual that is authorized to transact on behalf of the corporate entity or trust.

• Valid vehicle registration for the vehicle listed in Step 3. Note: If you are a non-Volkswagen dealer, you may provide proof of acquisition in place of vehicle registration.

• Title (front and back). The registered owner is not required to be on the title, but there must be a name listed on the Claim that matches the title.

• If you do not have access to title, please provide proof of loan payment in place of the required title (front and back) documents. Proof of loan should include the account number, a current date (or the date of agreement if you are submitting a lien agreement), a full name that matches the name provided in Step 2 and a Vehicle Identification Number (VIN) that matches the Vehicle Identification Number (VIN) provided in Step 3.

• Proof of acquisition to confirm the date the vehicle was acquired.

• If you were not the registered owner and are filing a Claim on behalf of someone else, a Third-Party Authorization Form and your government-issued photo identification (front and back). To obtain a Third-Party Authorization Form, please visit the “Documents” section of www.BoschVWSettlement.com or call toll-free 1-844-305-1928.

• If the vehicle was registered to a corporate entity, a corporate document showing your authority to transact on behalf of the corporate entity, such as Articles of Incorporation, Partnership Agreement or Certificate of Assumed Name/Doing Business As (“DBA”) Filing, and a current and valid government-issued photo identification (front and back) for the individual with authority.

• If you selected the “Yes” box for the question “Are you filing a Claim on behalf of a decedent’s estate?” in Step 2, please submit all of the following documents. If you did not select this box, you do not need to submit these documents.

○ A death certificate for the decedent; and, ○ A Third-Party Authorization Form; and, ○ A copy of your current and valid government-issued photo identification (front and back).

Please skip to Step 9 to sign and complete this form.

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BOSCH SETTLEMENT CLAIM FORM

STEP 5: VEHICLE TOTALED AND SOLD TO AN INSURANCE COMPANY AFTER SEPTEMBER 16, 2016 (2.0-LITER VEHICLES),

OR JANUARY 31, 2017 (3.0-LITER VEHICLES)

OWNERSHIP INFORMATION

If you totaled and transferred the vehicle identified in Step 3 to an insurance company, please fill out the information below. If you did not total and transfer your vehicle to an insurance company after September 16, 2016 (2.0-liter vehicles), or January 31, 2017 (3.0-liter vehicles), please skip to Step 6.

Please enter the date that you purchased the vehicle: (Documentation will be required.)

– –MM DD YY

Please enter the date that you sold the vehicle to an insurance company: (Documentation will be required.)

– –MM DD YY

Please enter the name of the insurance company to which the vehicle was sold

REQUIRED DOCUMENTATION: VEHICLE TOTALED AND SOLD TO AN INSURANCE COMPANY

If you are or were the registered owner of your vehicle, you must submit a copy of each of the following types of documentation with your Claim Form.

• Current and valid government-issued photo identification (front and back) of each registered owner named in Step 2.

• If the vehicle was registered to a corporate entity or a trust, a current and valid government-issued photo identification (front and back) of the individual that is authorized to transact on behalf of the corporate entity or trust.

• Valid vehicle registration as of the date the vehicle listed in Step 3 was totaled. Note: If you are a non-Volkswagen dealer, you may provide proof of acquisition in place of vehicle registration.

• If you selected the “No” box for the question “Can your vehicle be driven under its own 2.0-liter or 3.0-liter engine power?” in Step 3, and your vehicle was totaled and transferred to an insurance company after September 16, 2016 (for 2.0-liter vehicles), or January 31, 2017 (for 3.0-liter vehicles), submit one of the following documents. If you did not select the “No” box for that question in Step 3, you do not need to submit these documents.

○ A letter from the insurance company indicating that the vehicle was totaled, was transferred to the insurance company, and the date; or,

○ A copy of the vehicle title showing transfer of title to the insurance company.

• If you were not the registered owner and are filing a Claim on behalf of someone else, a Third-Party Authorization Form and your government-issued photo identification (front and back). To obtain a Third-Party Authorization Form, please visit the “Documents” section of www.BoschVWSettlement.com or call toll-free 1-844-305-1928.

• If the vehicle was registered to a corporate entity, a corporate document showing your authority to transact on behalf of the corporate entity, such as Articles of Incorporation, Partnership Agreement or Certificate of Assumed Name/Doing Business As (“DBA”) Filing, and a current and valid government-issued photo identification (front and back) for the individual with authority.

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BOSCH SETTLEMENT CLAIM FORM

• If you selected the “Yes” box for the question “Are you filing a Claim on behalf of a decedent’s estate?” in Step 2, please submit all of the following documents. If you did not select this box, you do not need to submit these documents.

○ A death certificate for the decedent; and, ○ A Third-Party Authorization Form; and, ○ A copy of your current and valid government-issued photo identification (front and back).

• If you selected the “Yes” box for the question “Did your vehicle have a Branded Title of Assembled, Dismantled, Flood, Junk, Rebuilt, Reconstructed, or Salvage on September 18, 2015?” in Step 3, submit one of the following documents. If you did not select this box, you do not need to submit these documents.

○ A copy of the vehicle registration dated prior to September 18, 2015; or, ○ A copy of the vehicle title dated prior to September 18, 2015; or, ○ A proof of acquisition.

Please skip to Step 9 to sign and complete this form.

STEP 6: CURRENT LESSEE INFORMATION

CURRENT LESSEE INFORMATION

If you currently lease the vehicle identified in Step 3 from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc., please fill out the information below. If you do not currently lease the vehicle, please skip to Step 7.

Is your lease through VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc.? (Select one.)

Yes

No

Please enter the date that you started your lease of the vehicle: (This will be independently verified.)

– –MM DD YY

By checking this box and signing this form, I authorize the release of all information pertaining to my lease, loan, or title, including but not limited to: contract, interest paid, payment history, and payment information, to Robert Bosch GmbH, Robert Bosch LLC, and Epiq Systems, Inc. (the Court-Appointed Claims Administrator).

Print Name of Lessee 1:

Signature of Lessee 1: Date: – –

MM DD YY

Print Name of Lessee 2 (if applicable):

Signature of Lessee 2 (if applicable):

Date: – –MM DD YY

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BOSCH SETTLEMENT CLAIM FORM

REQUIRED DOCUMENTATION: CURRENT LESSEE

If you currently lease your vehicle, you must submit a copy of each of the following types of documentation with your Claim Form.

• Current and valid government-issued photo identification (front and back) of each of the lessee(s) named in Step 2.

• If the vehicle was leased to a corporate entity or a trust, a current and valid government-issued photo identification (front and back) of the individual that is authorized to transact on behalf of the corporate entity or trust.

• Valid vehicle registration for the vehicle listed in Step 3.

• Proof of lease with VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc. Documentation must include lease start date, Vehicle Identification Number (VIN), claimant name, and proof of leasing agent.

• Proof of acquisition to confirm the lease start date.

• If you were not the registered lessee and are filing a Claim on behalf of someone else, submit a Third-Party Authorization Form authorizing you to act on their behalf and a copy of your current and valid government-issued photo identification (front and back). To obtain a Third-Party Authorization Form, please visit the “Documents” section of www.BoschVWSettlement.com or call 1-844-305-1928.

• If the vehicle is leased to a corporate entity, a corporate document showing your authority to transact on behalf of the corporate entity, such as Articles of Incorporation, Partnership Agreement, or Certificate of Assumed Name/Doing Business As (“DBA”) Filing.

• If you selected the “Yes” box for the question “Are you filing a Claim on behalf of a decedent’s estate?” in Step 2, please submit all of the following documents. If you did not select this box, you do not need to submit these documents.

○ A death certificate for the decedent; and, ○ A Third-Party Authorization Form; and, ○ A copy of your current and valid government-issued photo identification (front and back).

Please skip to Step 9 to sign and complete this form.

STEP 7: FORMER LESSEE INFORMATION

FORMER LESSEE INFORMATION

If you formerly leased your vehicle from VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc., and did not purchase the vehicle at the end of the lease, please fill out the information below. If you did not formerly lease the vehicle, please skip to Step 8.

Did you lease this vehicle through VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc.? (Select one.)

Yes

No

Please enter the date that you started your lease of the vehicle: (This will be independently verified.)

– –MM DD YY

Please enter the date when you ended your lease of the vehicle: (This will be independently verified.)

– –MM DD YY

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BOSCH SETTLEMENT CLAIM FORM

By checking this box and signing this form, I authorize the release of all information pertaining to my lease, loan, or title, including but not limited to: contract, interest paid, payment history, and payment information, to Robert Bosch GmbH, Robert Bosch LLC, and Epiq Systems, Inc. (the Court-Appointed Claims Administrator).

Print Name of Lessee 1:

Signature of Lessee 1: Date: – –

MM DD YY

Print Name of Lessee 2 (if applicable):

Signature of Lessee 2 (if applicable):

Date: – –MM DD YY

REQUIRED DOCUMENTATION: FORMER LESSEE

If you formerly leased your vehicle, you must submit a copy of each of the following types of documentation with your Claim Form.

• Current and valid government-issued photo identification (front and back) of each of the lessee(s) named in Step 2.

• If the vehicle was leased to a corporate entity or a trust, a current and valid government-issued photo identification (front and back) of the individual that is authorized to transact on behalf of the corporate entity or trust.

• Proof of lease termination with VW Credit, Inc. (a.k.a. Volkswagen Credit, Inc.), Audi Financial Services, or Porsche Financial Services, Inc. Documentation must include lease start date, Vehicle Identification Number (VIN), claimant name, and proof of leasing agent.

• Proof of acquisition to confirm the lease start date.

• If you were not the registered lessee and are filing a Claim on behalf of someone else, submit a Third-Party Authorization Form authorizing you to act on their behalf and a copy of your current and valid government-issued photo identification (front and back). To obtain a Third-Party Authorization Form, please visit the “Documents” section of www.BoschVWSettlement.com or call 1-844-305-1928.

• If the vehicle is leased to a corporate entity, a corporate document showing your authority to transact on behalf of the corporate entity, such as Articles of Incorporation, Partnership Agreement, or Certificate of Assumed Name/Doing Business As (“DBA”) Filing.

• If you selected the “Yes” box for the question “Are you filing a Claim on behalf of a decedent’s estate?” in Step 2, please submit all of the following documents. If you did not select this box, you do not need to submit these documents.

○ A death certificate for the decedent; and, ○ A Third-Party Authorization Form; and, ○ A copy of your current and valid government-issued photo identification (front and back).

Please skip to Step 9 to sign and complete this form.

R50516 v.06 05.03.2017 Page 16 of 18016-CA9432

BOSCH SETTLEMENT CLAIM FORM

STEP 8: ELIGIBLE SELLER/ELIGIBLE FORMER OWNER INFORMATION

ELIGIBLE SELLER INFORMATION (2.0-LITER VEHICLES)

If you formerly owned the vehicle identified in Step 3 as of September 18, 2015, but sold or otherwise transferred ownership of the vehicle before June 28, 2016, please fill out the information below. Note that in order to receive benefits under the Bosch Settlement, as an Eligible Seller, you must have identified yourself by registering with the Bosch Settlement no later than May 1, 2017. If you did not formerly own the vehicle, please skip to Step 9.

Did you own the vehicle on September 18, 2015? (Select one.)Yes

No

Did you sell the vehicle after June 28, 2016? (Select one.)Yes

No

Please enter the date that you purchased the vehicle: (Documentation will be required.)

– –MM DD YY

Please enter the date that you sold the vehicle: (Documentation will be required.)

– –MM DD YY

ELIGIBLE FORMER OWNER INFORMATION (3.0-LITER VEHICLES)

If you formerly owned the vehicle identified in Step 3 as of September 18, 2015, and/or November 2, 2015, but sold or otherwise transferred ownership of the vehicle before January 31, 2017, please fill out the information below. Note that in order to receive benefits under the Bosch Settlement, as an Eligible Former Owner, you must have identified yourself by registering with the Bosch Settlement no later than May 1, 2017. If you did not formerly own the vehicle, please skip to Step 9.

Did you own the vehicle on September 18, 2015, and/or November 2, 2015? (Select one.)Yes

No

Did you sell the vehicle after January 31, 2017? (Select one.)Yes

No

Please enter the date that you purchased the vehicle: (Documentation will be required.)

– –MM DD YY

Please enter the date that you sold the vehicle: (Documentation will be required.)

– –MM DD YY

R50517 v.06 05.03.2017 Page 17 of 18017-CA9432

BOSCH SETTLEMENT CLAIM FORM

REQUIRED DOCUMENTATION: ELIGIBLE SELLER/ELIGIBLE FORMER OWNER

If you formerly owned your vehicle, you must submit a copy of each of the following types of documentation with your Claim Form.

• Current and valid government-issued photo identification (front and back) of the former owner(s) named in Step 2.

• If the vehicle was owned by a corporate entity or a trust, a current and valid government-issued photo identification (front and back) of the individual that is authorized to transact on behalf of the corporate entity or trust.

• Proof of former ownership and sale. Submit one of the following documents: ○ A copy of the Bill of Sale identifying the former owner(s) named in Step 2 as the seller, the date of sale,

and the Vehicle Identification Number (VIN); or, ○ A copy of vehicle title identifying the former owner(s) named in Step 2 as the transferor, the date of

transfer, and the Vehicle Identification Number; or, ○ Proof of notification to the Department of Motor Vehicles (DMV) (or applicable state agency) that

the vehicle was sold and the registration was cancelled, including the date and Vehicle Identification Number (VIN).

• Proof of acquisition to confirm the date vehicle was acquired.

• If you were not the registered owner and are filing a Claim on behalf of someone else, submit a Third-Party Authorization Form authorizing you to act on their behalf and a copy of your current and valid government-issued photo identification (front and back). To obtain a Third-Party Authorization Form, please visit the “Documents” section of www.BoschVWSettlement.com or call 1-844-305-1928.

• If the vehicle is owned by a corporate entity, a corporate document showing your authority to transact on behalf of the corporate entity, such as Articles of Incorporation, Partnership Agreement, or Certificate of Assumed Name/Doing Business As (“DBA”) Filing.

• If you selected the “Yes” box for the question “Are you filing a Claim on behalf of a decedent’s estate?” in Step 2, please submit all of the following documents. If you did not select this box, you do not need to submit these documents.

○ A death certificate for the decedent; and, ○ A Third-Party Authorization Form; and, ○ A copy of your current and valid government-issued photo identification (front and back).

• If you selected the “Yes” box for the question “Did your vehicle have a Branded Title of Assembled, Dismantled, Flood, Junk, Rebuilt, Reconstructed, or Salvage on September 18, 2015?” in Step 3, submit one of the following documents. If you did not select this box, you do not need to submit these documents.

○ A copy of the vehicle registration dated prior to September 18, 2015; or, ○ A copy of the vehicle title dated prior to September 18, 2015; or, ○ A proof of acquisition.

Please skip to Step 9 to sign and complete this form.

R50518 v.06 05.03.2017 Page 18 of 18018-CA9432

BOSCH SETTLEMENT CLAIM FORM

STEP 9: SUBMISSION, CONSENT, AND SIGNATURE

By signing below I agree to allow Robert Bosch GmbH, Robert Bosch LLC (collectively, “Bosch”) and Epiq Systems, Inc. (“Epiq”) (the Court-Appointed Claims Administrator) to retain and use the information provided in this form to accomplish the purposes relevant to processing a Claim Form related to the Bosch Settlement or Bosch Settlement proceedings, including but not limited to contacting me with questions, updates, or information, using any or all of the provided information.

I provide permission for Bosch and Epiq to use, or share with third parties, the information in this form to administer the Bosch Settlement, which includes accessing, using, preserving, or disclosing the information when reasonably necessary to (a) comply with legal process or otherwise satisfy any applicable law or regulation; (b) prevent fraud or imminent harm; (c) ensure the security of information; or (d) address technical issues. For additional details concerning the use and disclosure of information collected in connection with the administration of the Bosch Settlement, please visit www.BoschVWSettlement.com and click on the link titled “Privacy Policy.”

Print Name 1:

Signature 1: Date: – –MM DD YY

Print Name 2 (if applicable):

Signature 2 (if applicable): Date: – –

MM DD YY

Submit this completed Claim Form along with any required documentation on or before December 31, 2019, (unless you are an Eligible Seller and missed the identification deadline in the 2.0-liter Volkswagen (VW) Settlement, or if you are an Eligible Former Owner and do not file a Claim in the 3.0-liter Volkswagen (VW) Settlement, in which case you must have begun your Claim submission process by registering with the Bosch Settlement on or before May 1, 2017, and you must complete your Claim submission on or before August 15, 2017; or unless you opted out of either or both of the 2.0-liter or 3.0-liter Volkswagen (VW) Settlements, in which case this form and any required documentation must be returned on or before August 15, 2017) by mail to the Claims Administrator at Bosch Settlement, P.O. Box 5110, Portland, OR 97208-5110, or by fax to 1-844-760-8029. Note: If submitting by fax, keep a copy of the fax confirmation.