Durom Cup Settlement Program

Settlement Program Forms

Use these forms to complete the Settlement Program process. More information on the Settlement Program process can be found at the Settlement Agreement tab, and in the Settlement Agreement.

If you are represented by an attorney for your Durom Cup claim, your attorney is responsible for submitting these documents for you. Do not submit these forms on your own behalf if you are represented by an attorney.

Durom Cup Inventory Registration Form (Exhibit A)

Unrepresented Durom Cup Claimant Registration Form (Exhibit B)

Categorization and Award Amount Form (Exhibit C)

Extraordinary Loss or Injury Claim Form (Exhibit D)

Mediation Request Form (Exhibit F)


Attachments to Individual Settlement and Release Agreement (Exhibit E):

Submit Your Forms

Sample Final Settlement and Release Agreements: