Kalima Lawsuit - Deceased Information Request Form

Deceased Information Request Form - Class Member Information

Under Hawai’i law, the money awarded to a deceased person will pass to persons named in a will or trust, or to certain family members if there is no will or trust (“intestate estate”). Probate court approval is required to approve the distribution of an intestate estate to family members. For that reason, please send us information about the deceased Settlement Class Member’s family using the following form.

Class Member Information:

First Name:*

Middle Initial:

Last Name:*

Date of Birth:*

Date of Death:*

Note: If you do not know the exact day, please select the 1st (Example: 05/01/2000).

Last 4 Digits of SSN:*

Place of Death:

Did the Settlement Class Member have a will or trust?*

The Class Member has a will.
The Class Member has a trust.
The Class Member has neither a will nor a trust.
It is not known if the Class Member has a will and/or a trust.

Executor/Trustee Name:*

Estate EIN:

Representative Information:

To complete this form on behalf of the Class Member, please answer the following questions.

1. Who is filling out this on behalf of the Class Member?

First Name:*

Middle Initial:

Last Name:*

2. What is your relationship to the Class Member?*

Please provide a what type of relationship you have with the Class Member.*

Are you currently receiving public benefits or under a disability that impacts legal capacity?*

Yes
No
I am not sure.

Contact Information:

All communications from the Claims Administrator will be directed to the information provided below.

Country:*

Address Line 1:*

Address Line 2:

City:

Province/Region:

Postal Code:

City:*

State:*

Province:*

ZIP Code:*

Postal Code:*

Phone Number:*

Email Address: