Forms

Bankruptcy Proceedings

Form V2055 for Use With CAP 2008-12 (Word) 78KB

Deceased Claimants

Form V2031 for Use With CAP 2008-1 (Word) 96KB

Form V2031DC for Use With CAP 2008-1 (Word) 96KB

Derivative Claimants

Form V2035 for Use With CAP 2008-8 (Word) 96KB

Future Evidence Stipulation Exemplar

Future Evidence Stipulation Exemplar (PDF) 90KB

Late Submissions

Form V2033: Request for Relief from Deadline (Word) 68KB

Lost Wage

Form V2052: Waiver of Claim for Lost Wages (Word) 49KB

Payment Forms

Form W-9: Request for Taxpayer Identification Number and Certification (PDF) 53KB

Form V4151: Election for Settlement Payments to be Transferred to Vioxx 468B Holding Settlement Sub-Fund (PDF) 121KB

Form V4152: Election for Settlement Payments to be Issued from Vioxx 468B Holding Settlement Sub-Fund (PDF) 130KB

Private Lien Resolution

Private Lien Resolution Program Offer and Acceptance Form (Word) 79KB

Withdrawal of Claim

Form V2056 for Use With CAP 2008-13 (Word) 74KB

Withdrawal of Counsel

Form V2070 for use with CAP 2009-1 (Word) 75KB

Registration

Registration of Claims Spreadsheet (Updated 12/07/07) (Excel) 5.03MB

Registration of Claims Spreadsheet (Updated 12/07/07) (Excel - Compressed Zip File) 473KB

Registration Affidavit: Primary Counsel (Word) 47KB

Registration Affidavit: Pro Se (Word) 54KB

Enrollment

Primary Counsel

Enrollment Form for Use After Second Amendment (Word) 52KB

Stipulation of Dismissal with Prejudice (Word) 29KB Click here

Certification of Final Enrollment (Word) 38KB Click here

Certification of Final Enrollment - Attachment A (Word) 40KB

 

Unrepresented Claimants

Enrollment Instructions for Unrepresented Claimants (PDF) 45KB

Unrepresented Claimant Enrollment Form (PDF) 15KB

 

Other Forms

Form V2042: Certification of Counsel Pages for Releases: Cure for Selected Deficiencies (PDF) 15KB

Claims Package Submission

Claims Form (PDF) 84KB

Certification Template for Pre-11/9/07 Record Requests (PDF) 11KB

Pill Count Calculator (Excel) 117KB