Kia Engine Settlement - Submit a Claim Page 1

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Contact Information:

Claimant Type:*

First Name:*

Middle Initial:

Last Name:*

Business/Entity Name:*

Representative Name:

Country:*

Address Line 1:*

Address Line 2:

Address Line 3:

Address Line 4:

Address Line 5:

City:*

State:*

Province:*

ZIP Code:*

Postal Code:*

Phone Number:

Email Address:*

Class Vehicle Information:

Please enter your 17-digit Vehicle Identification Number (VIN):*

Current Mileage:*