Payment Forms

Centralized Process for
Representative Appointment

IRS Form W-9

SWS-5(B) (Sworn Statement: Status of Assignment of Monetary Claim Not Involving Resolution Protocol)

SWS-5(A) (Sworn Statement: Status of Assignment of Monetary Claim Involving Resolution Protocol)

Declaration of Consent to Substitution

Termination and Release Agreement

Unrepresented Settlement Class Member Payment Election Form

Law Firm Payment Election Form

SWS-5 (Sworn Statement: Status of Assignment of Monetary Claim)

Declaration of Consent to Substitution

Waiver Relinquishing Rights Under Attempted Assignment

Termination and Release Agreement

Most Viewed Forms

Claim Form for Retired NFL Football Players and Representative Claimants

Pre-Effective Date Diagnosing Physician Certification Form

MAF Diagnosing Physician Certification Form

Authorization for Release of Claims Information (Appendix A)

Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Retired Player)

Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Knowledgeable Informant)

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