Instructions for Submitting Your Consumer Claim Form

If you are a member of the Class as a consumer, you may file a claim for a share of the Settlement Fund. You must submit your claim online at, no later than August 11, 2022.

1. Complete Section A.
2. Answer the question in Section B to determine your eligibility.
3. Provide information about your total purchases of Restasis® in Section C.
4. If possible, provide documentation of at least one purchase of Restasis® as described in Section D.
5. Review and sign the Claim Form in Section E, which includes the Certification that the information you provide is true and correct to the best of your knowledge.

  • By signing and submitting the Claim Form, you are swearing under penalty of perjury that you qualify to submit a claim according to the criteria given in Section B. You will receive an acknowledgement that your claim has been submitted. Your electronic signature and submission of the form will conform to the requirements of the Electronic Signatures Act, 15 U.S.C. § 7001, et seq., and will have the same force and effect as if you signed the Claim Form in hard copy.
  • If your completed Claim Form is not submitted by August 11, 2022, you will not receive any payment from the Settlement. Submission of this Claim Form does not ensure that you will share in the payments related to the Settlement.