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By submitting this form you declare, under penalty of perjury, that all statements submitted herewith are true to the best of your knowledge. You understand that knowingly filing an application or statement of claim containing false, incomplete, or misleading information may constitute a criminal offense, and may also subject you to legal action by Total Japanese Domestic Motor Inc. to recover lost funds, costs and penalties. You confirm that you understand and agree to our Terms & Conditions. You further understand and agree that by accepting any decision from this claims process, You will be waiving any right you might have had to file suit against Total Japanese Domestic Motor Inc., or its affiliates and subsidiaries related to the subject matter of this claim.

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