CLAIM FORM

Jean-Michel Normandin v. Bureau en Gros (Staples Canada ULC.)
(500-06-000547-105)

Your duly completed claim form must be submitted no later than March 31, 2023, failing which you will be deemed to have waived your right to submit a claim and your right to any compensation, damages or remedy of any kind.


SECTION A: CONTACT INFORMATION AND PAYMENT METHOD

Provide your name and contact information below. If your contact information changes after you submit this claim form, please provide the new information to the Claims Administrator.





SECTION B: SWORN DECLARATION











**If you are unable to affirm one or more of the above statements, including if you purchased an Extended Service Replacement Plan, you are not entitled to any amount**







For assistance, you may contact the Claims Administrator or class counsel:
Claims Administrator:

Velvet Payments
5900 Andover Ave.
Suite 1
Montreal, Quebec
H4T 1H5
beg@velvetpayments.com
1-888-770-6892
Class Counsel:

Cabinet BG Avocat Inc.
c/o Mtre Benoît Gamache
6090, Jarry est, suite B-4
Montréal (Qc) H1P 1V9
info@cabinetbg.ca
1-866-327-0123

OR

BGA Inc.
c/o Mtre David Bourgoin
67, Sainte-Ursule
Québec (Québec) G1R 4E7
info@bga-law.com
1-866-523-4222

Your claim has been registered.

OK

Error

OK