Please use this claim form to apply for reimbursement of out-of-pocket television LCD Panel repair or replacement costs on covered models — KDL-52XBR9, KDL-52Z5100 Sony® LCD televisions.

You must provide BOTH a copy of your purchase receipt of a qualifying TV model and an LCD Panel service receipt, each dated on or before August 31, 2012.

Please complete this entire form. Incomplete information or claim forms will not be processed. For check delivery by mail, please allow 8-10 weeks following Sony’s receipt of properly completed claim. Replacement of parts other than the LCD panel are not covered by this program. All submissions must be postmarked no later than November 30, 2012. Offer limited to U.S. resident end users who paid out-of pocket fees for LCD Panel estimates and/or repairs and is limited to costs of LCD Panel and labor expenses to replace it. Costs to repair damage arising due to misuse or abuse will not be covered under this program. Submitted materials become Sony property and will not be returned. Delivery to P.O. Boxes will not be accepted. Sony reserves the right to request additional information to validate a claim, making it subject to U.S. postal regulations. In consideration for Sony making this offer and by your claim submission, you agree to release Sony Electronics Inc., and its affiliates from any and all claims for damages, loss, cost, expense or liability both known and unknown, which you may have incurred in connection with the LCD Panel of your affected television set.

Offer available to end user consumers only and is not transferable. Offer is not available to providers, obligors, underwriters, or administrators of performance service plans, buyer protection plans, or other warranty or extended warranty programs. This offer is not part of the Sony limited warranty and all other terms of the Sony limited warranty continue to apply.

Customer Information
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
City: ________________________________ State: ______________ Zip Code: ____________________
Phone#: __________________________________________

TV Model Information
Sony TV Model Number: ________________________________________________________________
Serial Number (located on the back of the TV): _______________________________________________

Example:
Serial Number Label

Date of Purchase: _____________________ Retailer Where Purchased: __________________________

Service Information
Name of Servicer: _____________________________________________________________________
Date of Service: _______________________________________________________________________
Cost of Repair/Service Evaluation (dollars):
Evaluation fee: $____________
Parts: $___________________
Labor: $___________________
Total: $________________
Description of Repair / Other Information:
____________________________________________________________________________________
____________________________________________________________________________________


  I do not wish to receive information from Sony about products, services, premium programs, contests and offerings that may be of interest to me.

You must include:
(1) Copy of Purchase Receipt (dated on or before August 31, 2012)
(2) Copy of Service Receipt (dated on or before August 31, 2012)
(3) This Completed Form

CLAIM FORM SUBMISSIONS MUST BE POSTMARKED BY NOVEMBER 30, 2012

Mail this completed form to:
Sony Electronics Inc.
Attn: NSP TV Program
12451 Gateway Boulevard
Fort Myers, FL 33913

For questions, please call (888) 649-7669.