Tronox Trust Payout PDF Details

The Tronox Trust Payout Form, also known as the TROXPAY.EXE file, is a Microsoft Windows executable program that allows you to view and manage your trust account information. You can use the file to view account balances, transaction history, and distribution information. TROXPAY.EXE is a component of the Tronox Trust Administration software suite.

You'll find information regarding the type of form you would like to complete in the table. It will tell you just how long it should take to complete tronox trust payout, what parts you will need to fill in, and so forth.

QuestionAnswer
Form NameTronox Trust Payout
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namestronox claims update, tronox tort claims trust, tronoxtorttrust com, tronox tort claims trust form

Form Preview Example

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

TRUST CLAIM FORM

This claim form sets forth your claim for recovery under the Tronox Incorporated Tort Claims Trust Distribution Procedures (“TDPs”). Please carefully follow all of the instructions in this claim form and complete this claim form as thoroughly and accurately as possible. Should there be insufficient space to list all of the relevant information, please attach additional sheets.

Capitalized terms not defined in this claim form are defined in the TDPs and the Instruction Letter. Please review the documents and claims materials carefully. Nothing in this Trust Claim

Form, the Cover Letter, or the Instruction Letter is intended to replace or modify the requirements of the Plan, the TDPs, or the Arbitration Procedures. All Claimants are encouraged to read thoroughly and understand the TDPs and the Arbitration Procedures before filing a Tort Claim.

In addition to filing this claim form, you will need to provide certain documents to support your Claim. This claim form will provide instructions concerning the additional documentation you need to submit. Please review it carefully and enclose all of the required documentation.

Once this claim form is completed, it must signed by the Claimant or the Claimant’s attorney. If you are represented by an attorney, it is important to ask him or her any questions you have about this claim form before you sign it. If someone else prepared this claim form for you, review its contents carefully. You are responsible for the accuracy of all information provided to the Tort Claims Trust in this claim form.

1 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 1: LEGAL REPRESENTATION

A. Attorney Name:

 

 

 

Last Name (and suffix, if applicable)

Given Name (First)

M.I.

 

 

 

 

 

 

 

 

 

B. Law Firm Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Law Firm

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

Street Number and Street Name

 

 

 

Suite or Floor

 

 

 

 

 

 

 

 

 

 

 

City

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

D. Attorney Contact

 

Phone

________________

E-mail

______________________

Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Paralegal or Contact

 

 

 

 

 

 

 

Name:

 

 

 

 

 

Last Name (and suffix, if applicable)

Given Name (First)

M.I.

 

 

 

 

 

 

F. Contact Information for

 

 

 

 

 

Paralegal or Contact

 

Phone

________________

E-mail

______________________

Person:

 

 

 

 

 

 

 

Page 2 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 2: INJURED PARTY INFORMATION

A. Current Legal Name:

 

 

Family Name (Last), and suffix if applicable

Given Name (First)

M.I.

If the Injured Party is a business

 

 

 

 

 

 

 

 

 

(partnership, corporation,

or LLC),

 

 

 

 

 

 

 

 

 

include the name of the business and

 

 

 

 

 

 

 

 

 

the name of an authorized officer of

 

 

 

 

 

 

 

 

 

the business above:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business name

 

 

D/B/A

 

 

 

 

 

 

 

 

 

 

 

B. Identification Number: U.S. Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Or Alternate Identification

Type:

 

 

No.:

 

 

 

Or Business EIN / Tax ID#

No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Date of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Home Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

Apt. No.

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

E. Contact Info.:

Phone

 

 

E-mail

 

 

 

 

 

 

 

 

 

 

F. Is the Injured Party deceased?

 

Yes (Complete Part 3)

No (Skip Part 3)

If Yes, please provide the date of death: ____________________

 

 

 

 

 

 

 

 

Month

Day

Year

 

 

 

Page 3 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 3: OFFICIAL REPRESENTATIVE OF DECEASED, INCOMPETENT, OR MINOR INJURED PARTY

A. Current Legal Name:

Last Name (and suffix, if applicable)Given Name (First)M.I.

B. Home Address:

 

Street Number and Street Name

 

 

 

Apt. No.

 

 

 

 

 

 

 

City

 

 

State

Zip Code

 

 

 

 

 

C. Contact Info.:

Phone

 

E-mail

 

 

D.Death Certificate: If the Injured Party is deceased and you are filing a claim on his or her behalf, you must attach a copy of the Injured Party’s death certificate to this claim form. If the Injured Party is deceased, but you are not able to provide a copy of his or her death certificate, please explain why in the space below.

Check One of the Following:

The Injured Party is not deceased.

A copy of the Injured Party’s Death Certificate is attached.

A copy of the Injured Party’s Death Certificate is NOT attached, for the following reason:

___________________________________________________________________________________

___________________________________________________________________________________

__________________________________________________________________________________

E.Certificate of Official Capacity or Other Estate Documentation: If you are the Injured Party’s personal representative and the applicable state’s law requires you to obtain a certificate of official capacity or other documentation to show that you are authorized to act on the Injured Party’s behalf, you must attach a copy of the certificate or other documentation to this claim form. If you are acting on behalf of the Injured Party but are unable to attach a copy of the certificate of official capacity or other documentation, please explain why in the space below.

Check One of the Following:

A copy of the certificate of official capacity or other estate documentation required by applicable state law is attached.

Applicable state law does not require a certificate of official capacity or other estate document, and therefore no certificate is attached.

A copy of the certificate of official capacity, although required by state law, is NOT attached, for the following reason:

___________________________________________________________________________________

___________________________________________________________________________________

__________________________________________________________________________________

Page 4 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 4: CATEGORY C - PROPERTY DAMAGE CLAIMS

To support your Property Damage Claim, you must submit the following information:

A.Proof of Claim that was filed on the Injured Party’s behalf in Tronox’s bankruptcy proceeding. Please check the box below to confirm that you are attaching the Proof of Claim.

I am attaching a Proof of Claim

Note: If a Proof of Claim was not filed on the Injured Party’s behalf in Tronox’s bankruptcy proceeding, you cannot file a Property Damage Claim. You must instead submit your Claim for consideration as a Future Tort Claim. Please visit the Trust’s website at www.tronoxtorttrust.com and download the claims materials for Category A Claims for instructions on how to file a Future Tort Claim.

B.Claimed Amount of Damages (for Your Claim Only):

C.Address of Property at Issue:

D.Tronox Debtor Allegedly Liable for Damage to Property:

E.All documents and information you intend to rely upon in arbitration to support your claim.

I am attaching the following documents (please list; attach separate sheet if necessary):

F.A copy of any pleadings and dispositive motions from any lawsuit filed by you or on your behalf arising from or relating to the property damage that is the basis of your Property Damage Claim.

I am attaching the following documents (please list; attach separate sheet if necessary):

Page 5 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 5: RECOVERY FROM OTHER DEFENDANTS

All Claimants must provide information concerning any recoveries the Injured Party (or the Injured Party’s Official Representative) received from other defendants and claims-resolution organizations related to the Injured Party’s Claim. Check the boxes below that best identify the status of any recoveries from other defendants:

(1) The Injured Party (or his Official Representative) has not asserted a claim related to the one asserted above against another defendant or claims-resolution organization.

(2) The Injured Party (or the Injured Party’s Official Representative) has received payment (or has a right to receive payment) from another defendant or claims- resolution organization on a claim related to the one asserted above.

If you checked box 2, please provide the following information:

A. Payer’s Name:

B. Payer’s Address:

 

Street Number and Street Name

 

 

 

Suite or Floor

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

State

Zip Code

C. Payer’s Contact

Phone

E-mail

 

 

 

Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Amount of

 

 

 

 

 

 

 

 

 

 

Payment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Source of

______________________________________

 

 

 

Payment:

 

 

 

 

 

 

 

 

 

 

F. For Payments

_________________________________________________________

 

from Court Awards

Name of Case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and Settlements:

 

 

 

 

 

 

 

 

 

 

(Please attach (1) a copy of

 

 

 

 

 

 

 

___

 

the most recent complaint

Case Number

 

Jurisdiction Where Case Was Pending

 

 

 

and (2) the verdict, order, or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

settlement agreement setting

_________________________________________________________

 

forth the amount of the

Description of Claim

 

 

 

 

 

 

award)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. For Payments

_________________________________________________________

 

from Insurance:

Type of Policy Under which Payment Was Made (i.e., Liability, No-Fault, Workers’ Compensation)

 

 

 

 

 

 

 

 

 

 

 

 

___________________________

 

 

 

State in which Policy Was Issued

 

Policy Number

 

 

 

 

 

 

 

 

 

Page 6 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

(3) The Injured Party (or the Injured Party’s Official Representative) has asserted a claim against another defendant or claims-resolution organization that is related to the Claim asserted above, and the claim has not yet been resolved (whether by verdict, judgment, settlement, or otherwise).

If you checked box 3, please provide the following information:

A.Defendant’s/

Organization’s

Name:

B.Defendant’s/

Organization’s

Address:

C.Defendant’s/

Organization’s Contact Information:

D.Case/Claim

Information:

(Please attach a copy of the most recent complaint or clam form)

 

 

 

Street Number and Street Name

 

Suite or Floor

 

 

 

City

State

Zip Code

 

 

 

PhoneE-mail

Name of Case/Claim

Case/Claim Number

Jurisdiction Where Case /Claim Is Pending

Description of Case/Claim

(4) The Injured Party (or the Injured Party’s Official Representative) had asserted a claim against another defendant or claims-resolution organization that was related to the Claim asserted above, and the claim was dismissed with prejudice or was denied.

If you checked box 4, please provide the following information:

A.Defendant’s/

Organization’s

Name:

B.Defendant’s/

Organization’s

Address:

Street Number and Street Name

Suite or Floor

City

State

Zip Code

Page 7 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

C.Defendant’s/

Organization’s Contact Information:

D.Case/Claim

Information:

(Please attach a copy of the order or notice dismissing or denying the case or claim)

PhoneE-mail

Name of Case/Claim

Case/Claim Number

Jurisdiction Where Case /Claim Was Pending

Description of Case/Claim

Page 8 of 9

TRONOX TORT CLAIMS TRUST

TRUST CLAIM FORM (CATEGORY C)

PART 6: SIGNATURE PAGE

All Claims must be signed by the Claimant or the Claimant’s attorney.

If signed by the Claimant: I (the Injured Party or the Injured Party’s Official Representative) have reviewed the information submitted on this claim form and all documents submitted in support of this claim. Pursuant to 28 U.S.C. § 1746, I declare under penalty of perjury under the laws of the United States of America that the information submitted is true and correct.

If signed by the Claimant’s attorney: I (counsel to the Injured Party or the Injured Party’s Official Representative) certify that the information and materials with respect to this claim are being submitted pursuant to and subject to the provisions of Rule 11 of the Federal Rules of Civil Procedure.

___________________________________________________________________________________

Signature of Claimant or Claimant’s Attorney

___________________________________________________________________________________

Please print the name and relationship to the Injured Party of the signatory above

Date: / /

(month) (day) (year)

4455235.1

Page 9 of 9

Watch Tronox Trust Payout Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .