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Exhibit B UNREPRESENTED DURUM CUP CLAIMANT REGISTRATION FORM On or before April 29, 2016, claimants who are not represented by counsel and who wish to participate in the Settlement Program must register
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How to fill out unrepresented Durom Cup claimant:

01
Obtain the necessary forms from the Durom Cup claimant website or legal assistance organizations.
02
Carefully read through the instructions provided with the forms to understand the requirements and the information needed.
03
Begin by filling out your personal information accurately, including your full name, contact information, and any other details required.
04
Provide a detailed account of your experience with the Durom Cup implant, including any negative effects or complications you have experienced.
05
Include any medical records or documentation that supports your claim, such as X-rays, lab reports, or surgeon's notes.
06
Detail any expenses you have incurred due to the Durom Cup implant, such as medical bills, medication costs, or lost wages.
07
If applicable, provide information about any physical or emotional pain and suffering you have endured as a result of the Durom Cup implant.
08
Sign and date the completed form, and make copies for your records.
09
Submit the filled-out form and accompanying documents as per the instructions provided, whether it is through mail or online submission.

Who needs unrepresented Durom Cup claimant:

01
The unrepresented Durom Cup claimant is an individual who has experienced complications or negative effects from the Durom Cup implant and is pursuing a legal claim without the assistance of legal representation.
02
This may include patients who have not hired a lawyer or have chosen to handle the claim on their own due to financial limitations or other reasons.
03
They may also be individuals who have chosen to represent themselves in legal proceedings and navigate the claims process independently.
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Unrepresented durom cup claimant refers to individuals who are filing a claim related to a defective Durom Cup hip implant without legal representation.
Individuals who have been affected by a defective Durom Cup hip implant and choose to file a claim without legal representation are required to file unrepresented durom cup claimant.
Unrepresented durom cup claimant can be filled out by providing all necessary information related to the defective Durom Cup hip implant, including personal details, medical records, and details of the implant procedure.
The purpose of unrepresented durom cup claimant is to allow individuals affected by a defective Durom Cup hip implant to seek compensation and justice without the need for legal representation.
Information such as personal details, medical records related to the defective hip implant, details of the implant procedure, and any additional evidence supporting the claim must be reported on unrepresented durom cup claimant.
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Relevant keywords

2016 Indiana CLAIMANT YYYY DUROM duromsettlement Zimmer Unfiled infoduromsettlement SSN LLP Ste Faegre Daniels claimants Categorization UNREPRESENTED Attn DOB CERTIFICATION Revision II defined reduction

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