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STEP 03Confirmation

First Name *
Last Name *
Contact Title
Phone *
- -
Email *
Address 1 *
Address 2
City *
State *
Zip Code *
Enter a VIN * Where can I find my VIN Your Vehicle's identification Number can be found here:
Left hand corner of the dash, driver's side.
Inside door panel, driver's side.
Any Registration/Insurance forms.
Any Sales Contact forms.

Invalid VIN. Please verify.
Mileage at the time of Repair, Engine Failure or Engine Fire *
Date of Repair, Engine Failure or Engine Fire *

I AM REQUESTING REIMBURSEMENT FOR RENTAL CAR / TOWING / OTHER COSTS INCURRED FOR ENGINE STALLING, KNOCKING, ENGINE FAILURE, ENGINE FIRE, ILLUMINATION OF THE OIL LAMP, OR OTHER ENGINE SHORT BLOCK ASSEMBLY REPAIR.

Please only select this option if you are requesting Reimbursement within 90 days of the date the expense was incurred or paid,whichever is later.

If your costs were incurred or paid more than 90 days ago, your claim for this option will be denied.

Please provide the total amount of rental car, towing, and/or other costs (including repossession or other financing-based damages) for which you are requesting reimbursement:

Documentation: Enclose a receipt or document showing all of the below:

- What was purchased (e.g., a rental car or towing service)

- Date of purchase

- Amount paid (e.g., credit card receipt, credit card statement, or bank statement) (If you paid in cash and have no receipt, your electronic signature on this Claim Form will constitute your attestation, under penalty of perjury, that you [or a friend or family member] paid for the repair in cash and do not have a receipt or documentation for the payment

- The date and nature of the corresponding repair (not needed if the repair was performed at a Kia dealership)

By checking this box, I certify that I paid in cash and have no receipt. I understand that my electronic signature on this Claim Form will constitute my attestation, under penality of perjury, that I(or a friend or family member) paid for the rental car, towing, and/or other costs in cash and do not have a receipt or documentation for the payment.

I AM REQUESTING COMPENSATION FOR INCONVENIENCE DUE TO REPAIR DELAYS EXCEEDING 60 DAYS.

Please only select this option if you are requesting reimbursement for repair delays that were completed within the last 90 days.

If your repair was completed more than 90 days ago, your claim for this option will be denied.

Please provide the total number of days it took to obtain any repairs done at an authorized Kia dealership:

I AM REQUESTING A CASH PAYMENT. (If you had delays between 61 and 90 days, you will be entitled to $50, and an additional $25 for each additional 30-day period [or fraction thereof] of delay.)

I AM REQUESTING A DEALER SERVICE CARD FOR 150% OF THE CASH PAYMENT I WOULD OTHERWISE BE ENTITLED TO FOR THIS BENEFIT.

Documentation: Enclose documents supporting the number of delayed days (e.g., repair order identifying open and close date).

I AM REQUESTING REIMBURSEMENT FOR A CLASS VEHICLE THAT EXPERIENCED AN ENGINE FIRE.

Please only select this option if you are requesting Reimbursement for Loss of Vehicle by Engine Fire and the engine fire occurred within the past 90 days.

If you are submitting a claim for an engine compartment fire that occurred more than 90 days ago, your claim for this option will be denied.

If you received any compensation for your vehicle after the engine fire (e.g. insurance payout), please provide the total amount you received:

- If you check this box, Kia will contact you about your request for compensation.

- To potentially qualify for compensation, your vehicle must have experienced an engine fire as a result of an engine seizure, engine stall, engine noise, or illumination of the oil lamp due to a connecting rod bearing failure, or symptoms associated with connecting rod bearing failure, that resulted in your loss of the vehicle.

- You must submit this Claim no later than 90 days after the engine compartment fire occurred.

- You are eligible for payment by KUS of the maximum Black Book value (i.e., private party/very good) of the Class Vehicle at the time of loss minus actual value received (if any).

- In addition to reimbursement for the vehicle, you are eligible to receive an additional $140 goodwill payment. If you have documents that you believe support your request for compensation, such as the repair facility diagnosis and paperwork showing what you received for your vehicle (if anything), providing those documents with this Claim Form may assist in the processing of your Claim.

I LOST FAITH IN MY VEHICLE UPON RECEIPT OF THE SETTLEMENT NOTICE, SOLD MY VEHICLE, AND PURCHASED A REPLACEMENT KIA VEHICLE.

Please only select this option if you are requesting Reimbursement for Loss of Faith in your vehicle and, the engine fire or failure occurred within the past 90 days and, you have purchased a replacement Kia vehicle.

If you are submitting a claim for an engine compartment fire or failure that occurred more than 90 days ago, your claim for this option will be denied.

Please provide the total amount you received from selling or trading in your vehicle:

Please provide the VIN of the Kia Vehicle you bought to replace your vehicle that experienced an engine failure or fire:

VIN of Replacement KIA Vehicle:

Invalid VIN. Please verify.

- If you check this box, Kia will contact you about your request for compensation.

- To potentially qualify for this compensation, you must sell your vehicle in an arm’s length transaction and purchase another Kia vehicle.

- To potentially qualify for compensation, your vehicle must have experienced an engine failure or an engine fire due to a connecting rod bearing failure or symptoms associated with connecting rod bearing failure.

- You must submit this Claim within 90 days of the event.

a. For model year 2011-2012 Class Vehicles: $2,000
b. For model year 2013 and 2014 Class Vehicles: $1,500
c. For model year 2015 and 2016 Class Vehicles: $1,000
d. For model year 2017, 2018, and 2019 Class Vehicles: $500

- If you have documents that you believe support your request for compensation, such as the repair facility diagnosis, paperwork showing what you received for your vehicle’s sale or trade-in, and paperwork showing proof of purchase of another Kia vehicle, providing those documents with this Claim Form may assist in the processing of your Claim.

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Please attach the following documentation:

For Rental Car/ Towing / Other costs:

- Receipt or document showing what was purchased (e.g. rental car or towing service)

- Receipt or document showing date of purchase

- Receipt or document showing amount paid (e.g. credit card receipt, credit card statement, or bank statement)
- Receipt or document showing the date and nature of the corresponding qualifying repair (not needed if the repair was performed at a Kia dealership)

For Compensation for Inconvenience Due to Repair Delays Exceeding 60 Days:

- Receipt or document supporting the number of delayed days (e.g. repair order identifying open and close date)
For Reimbursement for a Class Vehicle that Experienced an Engine Fire:

- Proof of loss event showing the actual value received (if any) for the vehicle (i.e. original or a copy of any document[s] generated pertaining to the loss that was incurred)

- Documentation establishing that the fire originated from the engine compartment and was unrelated to any sort of collision

For Loss of Faith in Vehicle Upon Receipt of the Settlement Notice:

- Receipt or document showing the date and nature of the corresponding qualifying repair (not needed if the repair was performed at a Kia dealership) or engine compartment fire

- Proof of sale or trade-in and value received for sale or trade-in

- Proof of purchase of a replacement Kia vehicle

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In accordance with California, Colorado, Connecticut, Delaware, Iowa, Montana, Nebraska, New Hampshire, New Jersey, Oregon, Texas, Virginia and Utah law, eligible state residents have several rights with regard to personal information, also known as personal data, that is collected by businesses. If you are an eligible resident of a state that grants its residents certain privacy rights, you have the following rights, subject to certain exceptions: (1) Right to Know/Access: You have the right to request access to the personal information maintained by Kia about you. This includes the right to request disclosure of the categories of personal information and specific pieces of personal information that Kia has collected about you. In response to requests for the categories, we will provide the categories of personal information we collected, the categories of sources from which we collected the personal information, our business or commercial purpose for collecting, selling or sharing the personal information, the categories of third parties to whom we sold, shared or disclosed the categories of personal information for a business purpose, and the business or commercial purpose for which we sold, shared or disclosed the categories of personal information. If you are a resident of Delaware, you also have the right to obtain a list of the categories of third parties to which Kia has disclosed personal information, and if you are a resident of Oregon, you can request to receive a list of specific third parties to which we have disclosed any personal information. (2) Right to Delete: You have the right to request that Kia delete any personal information about you that Kia has collected. Kia may decline to delete certain types of personal information about you in accordance with applicable law. (3) Right to Correct: You have the right to request that Kia correct inaccuracies in the personal information it maintains about you, taking into account the nature of the personal information and the purposes of the processing of your personal information. (4) Right to Opt-Out of Sale: If Kia sells personal information about you to third parties, you have the right to request that Kia not sell your personal information. (5) Right to Opt-Out of Sharing/Targeted Advertising: If Kia processes your personal information for the purpose of targeted advertising, you have the right to request that Kia not process your personal information for such purpose. (6) Right to Opt-Out of Profiling: If Kia processes your personal information for profiling purposes, you have the right to request that Kia not process your personal information for such purposes. (7) Right to Limit Use and Disclosure of Sensitive Personal Information: If you are a resident of California, you have the right, in certain circumstances, to limit how Kia uses and discloses your sensitive personal information. (8) Right to Appeal: You have the right to appeal Kia’s decision with regard to your request to exercise any privacy rights described herein. For certain requests, Kia will need to verify your identity before processing your requests to exercise the above rights. Further details on how to make requests, including our identity verification process, and your privacy rights more generally can be found in Kia's <a href='https://www.kia.com/us/en/privacy' target='_blank'>Privacy Policy</a>.