Use this form to submit a claim under the Romeo Settlement for Alternative Benefits.
If you do not currently own or lease your class vehicle, STOP HERE. You are not eligible to submit a claim for Alternative Benefits.
Purchase Price includes: the value of any trade in; applicable taxes; all finance charges specific to the cost of purchasing the vehicle (as described below); and (if applicable) OMVIC fee, freight fee, Federal Air Conditioning Tax, Quebec environmental levy, administration fees, dealer preparation fees and other fees payable at the time of purchase.
Purchase Price does not include: the costs of any modifications or additions after the vehicle’s purchase or the costs of any Ford Extended Service Plan or non-Ford service plan.
Lease Payments include: taxes paid by the Class Member with respect to a Class Vehicle to the lessor; any down payment made by the Class Member at the time of entering into the lease; and the value of any trade in at the time of entering into the lease.
Please enter the date of the first Service Visit on which a qualifying Transmission Hardware Replacement was performed.
Please select which Transmission Hardware part was replaced on this Service Visit (if more than one of these parts was replaced, you only need to select one part number)
Please upload the service records for this Service Visit below.
Please enter the date of the second Service Visit on which a qualifying Transmission Hardware Replacement was performed.
Please enter the date of the third Service Visit on which a qualifying Transmission Hardware Replacement was performed.
Please enter the date of the fourth Service Visit on which a qualifying Transmission Hardware Replacement was performed.
You do not need to submit any additional evidence that you owned the Class Vehicle at the time of the repairs.
To become eligible for Alternative Benefits your Class Vehicle must have failed a Transmission Diagnostic Test performed by a Ford Dealer of your choosing. Please complete the Preferred Ford Dealer information below. The Claims Administrator will provide you with a Transmission Diagnostic Test Form. You will then need to schedule the Transmission Diagnostic Test with your chosen Ford Dealer.
For further information about the Transmission Diagnostic Test procedure, please review question #41 in the ‘Understanding the Settlement’ section of the Long Form Notice, or FAQ#23 on the settlement website (www.fordtransmissionclassaction.com)
Please attach supporting documentation establishing:
Vehicle lease agreement showing VIN; a copy of the Class Vehicle registration showing proof of ownership at the time this claim is made; and evidence of the lease payments made under the lease agreement.
Vehicle purchase agreement showing VIN and total Purchase Price; and a copy of the Class Vehicle registration showing proof of ownership at the time this claim is made.
Vehicle purchase agreement showing VIN and total Purchase Price; a copy of the Class Vehicle registration showing proof of ownership at the time this claim is made; and evidence of the odometer reading at the time of purchase.
Please attach one of the following sets of documents establishing that you owned or leased the vehicle at the time of all the repairs that form the basis for your claim:
Maximum file size: 5 mb
Allowed file types: .jpg, .jpeg, .tif, .tiff, .gif, .png, .pdf, .xlsx
If the information or documentation you provide is incomplete, your claim may be rejected.
Required