Settlement Claim Forms. . .
Please read before selecting the form(s) you need:

If your name is in the class action database, you will need to complete one or more of the following forms in order to claim your benefit.

Please go to the Pension Search page for the Pension Benefit Guaranty Corporation (PBGC) and search for the name of the person who you think is a class member.

You may also get information from the office of the attorney for the class by calling 202-289-1118.

Completed forms should be mailed to the PBGC or the attorney for the class. See the help page for complete contact information.

Downloadable Forms
(PDF forms will open in a new window.)

  • A Response Form, which is a tax election form, must be completed by all class members.
  • Former W.T. Grant employees may be entitled to settlement benefits conditioned on proof of employment for 10 years or more. Select the Conditional Notice Form and fill in the spaces for Date of Hire, Date of Birth, and Social Security Number on page 1 of the form. You should also complete the Social Security Authorization form on page 2. This will allow the PBGC to confirm your employment.


Note: Each link will download a pdf file. You may click for free download of Acrobat Reader, which must be on your computer to read and print the forms.

Please select from the following:
View Letter with Questionnaire

Download and Print Questionnaire

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