Simmons et al. v. Apple Inc.

Case No. 17cv312251

Superior Court of the State of California, County of Santa Clara

Opt Out Form

Only use this Form if you want to request exclusion from (i.e., opt-out) of the proposed Class in Simmons et al. v. Apple Inc., Case No. 17-cv-312251. For more information on the proposed Settlement, please review the Detailed Notice of the Settlement.


This Form must be submitted online or postmarked to the Settlement Administrator later than November 20, 2020.

This Opt-Out Form may be submitted in one of two ways:

  1. Electronically through this form.
  2. Download an Exclusion Form by clicking HERE and mail to: Wireless Earphones Settlement Administrator, Attn: Exclusion Request P.O. Box 58220 Philadelphia, PA 19102.

To be effective as an opt-out from the proposed Settlement, this form must be completed, signed and sent, as outlined above, no later than November 20, 2020. If this form is not postmarked or submitted online by this date, you will remain a member of the Class.

Opting out of the Class is not the same as objecting to the Settlement Agreement. If you request exclusion from the Class prior to November 20, 2020, you will not be bound by the terms of the Settlement Agreement, and therefore cannot argue that the Settlement Agreement should not be approved.


Claimant Name (Required):

Claimant Identification Number (Optional):

Current Contact Information

Your contact information will be used by the Settlement Administrator to contact you, if necessary, about your opt out. Provision of your phone number is optional.


Through the submission of this form, I attest under the penalty of perjury of the laws of the United States that I have received notice of the class action Settlement in this case and I am a member of the class of persons described in the notice. I further attest that I request exclusion from the Settlement Class in Simmons et al. v. Apple Inc., Case No. 17-cv-312251. By signing below, I agree to the submission of this Opt-Out Form.

*Required Fields

Your Opt Out Request has been submitted successfully.

You will receive momentarily an email confirmation with the information below.
You may also print this page for your records.

Your Opt Out Request Details

First Name
Last Name
Claimant Identification Number
Mailing Address
Zip Code
Email Address
Preferred Phone Number

If you have any questions regarding your Opt Out Request, please email us at