Settlement Eligibility Form

Background
On February 1, 2016, Toyota Motor Credit Corporation settled certain claims with the Consumer Financial
Protection Bureau and the Department of Justice.
General Instructions
The settlement resulted in creation of up to a $21.9 million fund to pay individuals who are eligible for
benefits. To be eligible to take part in the settlement, you must meet the following criteria:
•You, or at least one co-buyer on the account, must be African-American, Black, Asian, Native
Hawaiian, or other Pacific Islander; and
• You must have purchased a vehicle between January 1, 2011, and August 1, 2016, that was financed
by Toyota Motor Credit Corporation.
After you submit the Settlement Eligibility Form, the government will make a determination of eligibility,
including determining whether you were overcharged.
By signing below, I declare under penalty of perjury that the following is true
Print Name
and correct (please check all boxes that apply):

I purchased a vehicle between January 1, 2011, and August 1, 2016, that was financed by
Toyota Motor Credit Corporation;
I am, or at least one co-buyer on the account is, African-American, Black, Asian, Native
Hawaiian, or other Pacific Islander; and
If determined to be eligible, I elect to participate in the settlement.

In order to confirm your eligibility to take part in the settlement, the Toyota Motor Credit Corporation
Settlement Administrator needs the following information:

First Name: MI: Last Name:

Address 1:

Address 2:

City: State: ZIP Code:

Phone Number:
– –
Email:

Last Four Digits of Social Security Number OR Toyota Motor Credit Corporation Account Number

– –
Signature: Date:
MM DD YY

Check here if this form is signed by a representative and attach proof of representation.

INSTRUCTIONS FOR SUBMISSION ON REVERSE

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 Instructions for Submission

In order to be considered to take part in the settlement, you must:

1. Fill out all parts of the Settlement Eligibility Form.
2. Sign and date the completed Settlement Eligibility Form.
3. Submit the Settlement Eligibility Form on or before MAY 8, 2018 by mail, email, online, or fax.

Mail: Toyota Motor Credit Corporation Settlement Online: www.TMCCSettlement.com

Settlement Administrator
P.O. Box 3775
Portland, OR 97208-3775

Email: info@TMCCSettlement.com Fax: 1-844-840-0630

Submissions must be accurate. You should keep a copy of this form for your records. If you have any questions
about how to fill out this form, please call the Toyota Motor Credit Corporation Settlement Administrator
at 1-844-778-5953.

After you submit your form, we will let you know whether you are eligible to take part in the settlement.

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