Moore v. Kimberly-Clark Worldwide, Inc.

Submit a Claim Form for the Kotex Settlement

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Moore v. Kimberly-Clark Worldwide, Inc.

In the Circuit Court for the 20th Judicial Circuit, County of St. Clair, State of Illinois

Case No. 19 L 0846

Settlement Claim Form

If you are a Class Member and wish to receive a payment, your completed Claim Form must be submitted on or before August 18, 2020.

Please read the Notice carefully before filling out and submitting this Claim Form.


Provide your name and contact information below. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form.


To qualify for a cash benefit, you must have purchased one or more of the following products (“Subject Products”) from March 8, 2013 through November 19, 2019:

  • U by Kotex® Tampons, including: U by Kotex® Sleek® Tampons, U by Kotex® Fitness® Tampons, U by Kotex® Click® Tampons, and U by Kotex® Security® Tampons in Regular, Super, and Super-Plus Absorbency.

Enter the total number of boxes of the Subject Products you purchased between March 8, 2013 and November 19, 2019:

If claiming more than 5 boxes, you must submit proof of purchase documentation to support the number of boxes claimed. (Select "Choose File" then "Upload." You may submit more than one file.)



POTENTIAL BENEFIT*: You may be entitled to receive a $6.00 cash benefit for every box of the Subject Products you purchased between March 8, 2013 and November 19, 2019, up to a maximum of $30.00 without Proof of Purchase. You may receive a full refund in cash benefits based on the total retail value of the Subject Products if you submit Proof of Purchase, such as receipts, establishing each purchase during the Class Period. Packaging, including bar codes or UPCs, shall constitute Proof of Purchase only if the Subject Product(s) claimed to have been purchased can be identified from the packaging submitted.**

The cash will be sent in the form of a check.

* The benefits set out herein represent the maximum that you can receive under the Settlement. The actual benefit may be reduced depending on the aggregate total of claims submitted by all Class Members.

**Failure to include Proof of Purchase for cash claims in excess of $30.00 will result in the claim being reduced to $30.00 in cash. Submission of false or fraudulent information may result in the claim being rejected in its entirety.


I declare under penalty of perjury under the laws of the United States of America that I purchased the products listed above between March 8, 2013 and November 19, 2019 and that all of the information on this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review.

Before submitting this Claim Form, please make sure you:
  1. Complete all fields in the Claimant Information section in Part One of this Claim Form.
  2. Provide the total number of boxes of the Subject Products you purchased between March 8, 2013 and November 19, 2019 in Part Two of this Claim Form.
  3. Indicate whether you are including Proof of Purchase documentation, and if so, upload all such documentation.
  4. Sign the Attestation under penalty of perjury in Part Three of this Claim Form. You must sign the Attestation in order to be eligible to receive settlement benefits.
  5. Note that after successful submission and our receipt of your Claim Form, a message will display on your screen confirming receipt and the assigned claim number. Note that you will not receive a separate email to confirm Claim Form receipt.

This website is authorized by the Court, supervised by counsel and controlled by the Settlement Administrator approved by the Court. This is the only authorized website for this case.

For more information please call (888) 484-0034.


Please read for a full explanation of the settlement and your options and all applicable timelines.


Contact us with any inquiries, comments, and/or requests.

Submit Claim

Click here to safely and securely submit a Claim Form.

Important Dates

  • Notice Program Begins

    Tuesday, May 19, 2020
    The Notice Program began on Tuesday, May 19, 2020.
  • Exclusion Deadline

    Monday, July 6, 2020
    You must complete and mail your Request for Exclusion so that it is postmarked no later than Monday, July 6, 2020.
  • Objection Deadline

    Monday, July 6, 2020
    Your objection(s) and/or notice of intent to appear at the Fairness Hearing must be filed with the Court on or before Monday, July 6, 2020 with a copy submitted to the Settlement Administrator, Plaintiffs' Counsel and Defense Counsel postmarked no later than Monday, July 6, 2020.
  • Claim Form Deadline

    Tuesday, August 18, 2020
    You must submit your Claim Form online no later than Tuesday, August 18, 2020 or mail your completed paper Claim Form so that it is postmarked no later than Tuesday, August 18, 2020.
  • Fairness Hearing Date

    Monday, July 20, 2020
    The Fairness Hearing is scheduled for Monday, July 20, 2020 at 10:00 a.m.  Please check this website for updates.

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