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

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice (i.e. 12345678).

We have received your Claim Form in the Chicco Booster Seat Settlement (Jimenez v. Artsana USA, Inc.). After further review, it has been determined that your claim is denied because you claimed to have made a purchase from Artsana’s website at chiccousa.com, but Artsana’s records show no evidence of a direct purchase by you. If you would like to contest your rejection, the deadline to submit your appeal is November 26, 2024.

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

I. CONTACT INFORMATION AND MAILING ADDRESS

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

* Required Fields

Note if your name and mailing address at the time of purchase is different from your current name and address, please provide your previous name and mailing address at the time of purchase:
If a different family member made the purchase on your behalf, please provide the full name and address of the individual who made the purchase.
II. PURCHASE INFORMATION

Below is the purchase information on file for your Eligible Product(s).

II. PROOF OF PURCHASE

Please upload any proof of purchase for the Chicco Booster Seat products you claimed.

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

    III. VERIFICATION AND ATTESTATION UNDER PENALTY OF PERJURY

    By signing below, I declare or affirm, under penalty of perjury, that I am the person to whom this notice is addressed, and that, to the best of my knowledge, the information on this Appeal Form is true and correct. I understand that my appeal may be subject to audit, verification, and/or Court review.

    Your Claim Form has been submitted successfully.

    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
    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@ArtsanaBoosterSeatSettlement.com

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