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CANADIAN DRAM NATIONAL
CLASS ACTIONS
SIMPLIFIED CLAIM FORM
Must Be Postmarked
No Later Than
June 23, 2015
Canadian DRAM Class Action
Claims Administrator
P.O. Box 3355
London, ON N6A 4K3
Tel: 1 (866) 855-5586
Complete this Claim Form to receive a payment from settlements totaling more than $79 million. It is expected that
a minimum payment of $20.00 will be distributed to eligible Class Members that submit a valid Claim Form. Your claim
must be postmarked by June 23, 2015.
Information on Claims Process and Claim Form
THESE INSTRUCTIONS APPLY TO PERSONS WHO DO NOT HAVE INTERNET ACCESS. IF YOU HAVE
INTERNET ACCESS, STOP READING THESE INSTRUCTIONS AND GO TO www.themoneyismine.ca.
You are automatically a class member if you:
•
you live in Canada now or you lived in Canada between April 1, 1999 and June 30, 2002; and
•
you bought DRAM or an electronic device containing DRAM for personal, commercial, or manufacturing use anywhere
in the world between April 1, 1999 and June 30, 2002;
OR
•
you live in the U.S. now or you lived in the U.S. between April 1, 1999 and June 30, 2002; and
•
you bought DRAM or an electronic device containing DRAM for personal, commercial, or manufacturing use in
Canada between April 1, 1999 and June 30, 2002.
How do I file a claim? Complete this claim form only if you do not have internet access. If you have internet access, you must file
your claim online at www.themoneyismine.ca. You must complete all sections of this claim form. Completed claims must be sent
to the following address postmarked no later than June 23, 2015.
Canadian DRAM Class Action
Claims Administrator
P.O. Box 3355
London, ON N6A 4K3
How can I get more information? More information about the settlements and the calculation of settlement benefits is available in
the Notice of Claims Process. If you did not receive the notice or have additional questions, please contact the Claims Administrator
toll free at 1 (866) 855-5586.
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Please Print in the Boxes Below (Do Not use Red Ink or Pencil)
Please Print in the Boxes Below (Do Not use Red Ink or Pencil)
PART I: CLAIMANT INFORMATION (FOR INDIVIDUAL)
PART I: CLAIMANT INFORMATION
First Name
Last Name
First Name
Last Name
Address 1
Address 1
Address 2
Address 2
City
Province Postal Code
City
Province
Telephone Telephone Postal Code
Telephone (Evening)
—
—
Email Address
—
—
Telephone (Evening)
—
—
—
—
Email Address
If you are filing this claim on behalf of a household, please enter the number of family members in your household. Please note family
members living in the same household must pool their purchases together and submit a single claim.
PART II: CLAIMANT INFORMATION (FOR BUSINESS)
Business Name
SIMPLIFIED V. STANDARD CLAIM FORM
There
areName
two different types of claims depending on your circumstances:
Contact
End Consumers Claiming $20 (Individuals, Households, Small Businesses)
Title
If you are an End Consumer claiming $20, we just need your name, contact information, and a declaration that you bought DRAM
or a product containing DRAM between 1999 and 2002. You do not need to provide any further proof of purchase. Simply complete
Address
PART A:1SIMPLIFIED CLAIM.
End Consumers
Claiming More than $20 but 2 CEUs or Less Per Person
Address
2
If you represent a household or commercial enterprise and you have 2 CEUs or less per family member or employee, we just need
your name, contact information, the number of family members or employees, the number of CEUs, and a declaration that the
City
Province Postal Code
information is true. Skip to PART B: STANDARD CLAIM.
Telephone Telephone (Evening)
—
—
—
Email Address
2
—
PART A. VERIFICATION (INDIVIDUAL ONLY)
I verify that I or the family members who currently reside with me have purchased at least 1 eligible DRAM Product for personal
use between April 1, 1999 and June 30, 2002
I understand, verify and agree to the following:
•
The Claims Administrator may contact me as the Claims Administrator deems appropriate for more information about
my claim.
•
The present claim relates to DRAM Products for which I/we have not been compensated and have given no release as
part of U.S. Proceedings or a private settlement.
•
No other family member currently residing with me has nor will submit a separate claim for compensation.
END CONSUMER PURCHASES
• I am at least 18 years old.
I/we purchased DRAM products as an End Consumer?
• I/we reside(d)
Canada
nowyour
or atDRAM
the time
of purchase
of the eligible DRAM or electronic device containing DRAM.
Yes
No in (If
Yes, list
purchases
below)
Quantity Purchased:
OR
•
– Laptops
Desktops
I/we reside(d) in U.S. Computers
now or at the
time of or
purchase
of the eligible DRAM or electronic device containing DRAM,
and made the purchase in Canada.
Printers
Memory Modules
PART
B. VERIFICATION (BUSINESS ONLY)
requestsGraphics
money has
purchased at least 1 eligible DRAM Product for its own use between
I verify that the business who hereby
Stand-Alone
Cards
April 1, 1999 and June 30, 2002
I understand, verify and agree to the following:
Video Game Consoles
• The Claims
Administrator may contact me DVD
as the Players
Claims Administrator deems appropriate for more information about
my claim.
Personal Digital Assistants (PDAs)
• The present claim relates to DRAM Products for which the business who hereby requests money has not been
compensated and has given no release as part
of U.S.
Proceedings or a private settlement.
MP3
Players
•
•
•
No other claim has been or will be submitted on behalf of the business who hereby requests money.
PVRs/Digital Video Recorders
I am at least 18 years old.
Servers (provide both the number of servers
and $
spent
The business
who hereby
money
reside(d)
in Canada now or at the time of purchase of the eligible DRAM or
purchased
and therequests
total dollars
spent
on servers)
electronic device containing DRAM.
Point of Sale Systems
OR
If you
morewho
thanhereby
10,000requests
DRAM money
memoryreside(d)
modules,inraw
is of
notthe
listed
in Table
1, please
• purchased
The business
U.S.DRAM,
now ororatthe
theDRAM
time ofProduct
purchase
eligible
DRAM
or
completeelectronic
the table device
below. containing
*Must be reported
in
Megabytes
(MBs)
by
year.
DRAM, and made the purchase in Canada.
Product Type
Quantity Purchased
Year Purchased
3
Total DRAM Content in MBs
PART III: DECLARATION
By submitting this claim I solemnly declare that the information provided in this Claim Form is true and correct.
Executed this________________ day of __________________________ in ___________________________________________
(Month/Year)(City/Province/Country)
(Sign your name here)
(Type or print your name here)
(Position)
PART IV: CONSENT TO USE INFORMATION IN OTHER CLASS ACTIONS
I want to receive emails about other similar class actions in Canada about computer components.
What are the other computer component class actions?
There are other similar class actions ongoing in Canada relating to price fixing of other computer components involving one or
more of the Class Counsel law firms. You may also be a class member in these other lawsuits involving:
•
•
•
•
LCD: 10” or larger liquid crystal displays, between 1998 and 2002;
SRAM: static random access memory, between 1998 and 2005;
Optical disc drives, between 2005 and the present; and
Lithium ion rechargeable batteries, between 2002 and 2012.
Whether you are eligible to claim in the listed class actions will depend on the outcome of those lawsuits and the terms of any
court orders or settlements in those lawsuits.
More information about these lawsuits, and the lawyers who are class counsel in them, is available at www.cfmlawyers.ca/class-actions.
What information will we keep for the other computer component class actions?
We would like to keep your name and contact information to send you information about these other lawsuits so that if you are
eligible, you can make a claim. We will keep your information secure.
What am I agreeing to?
If you check the box saying that you want to receive emails about other computer component class actions, you will be agreeing
to the following terms:
• The Claims Administrator (NPTRicePoint) keeping your name and contact information and providing it to the lawyers
who act as class counsel in the lawsuits listed above solely to provide you with notice of these class actions.
• If another company is appointed as administrator in the listed class actions, your information will be provided to that
company to be used solely to provide you with notice of that class action.
• Unless you write to the Claims Administrator at the address below to withdraw your agreement, your name and contact
information will be kept until the last of the listed lawsuits is completed, at which time it will be destroyed by any law firm
or claims administration firm that has it.
• For your information to be used in the listed class actions, the courts in those class actions must approve that use.
• Whether you are eligible to claim in the listed class actions will depend on the outcome of those lawsuits and the terms of any
court orders or settlements in those lawsuits.
You may write to the following at any time to withdraw your agreement:
Canadian DRAM Class Action Claims Administrator,
P.O. Box 3355, London, ON N6A 4K3
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ACCURATE CLAIMS PROCESSING TAKES A SIGNIFICANT AMOUNT OF TIME.
THANK YOU FOR YOUR PATIENCE.
Reminder Checklist:
1. Please sign the above declaration.
2. Keep a copy of your claim form.
3. If you move, please send the Claims Administrator your new address.
Privacy Statement
All information provided by the Claimant is collected, used, and retained by the Claims Administrator, Class Counsel and their
agents pursuant to the Personal Information Protection and Electronic Documents Act (PIPEDA) for the purposes of administering
the Canadian DRAM Class Action Settlement Agreements, including evaluating the Claimant’s eligibility status under the Settlement
Agreements. The information provided by the Claimant is strictly private and confidential and will not be disclosed without the
express written consent of the Claimant, except in accordance with the Settlement Agreements, distribution protocol or orders of
the courts.
“Class Counsel” is defined as Harrison Pensa LLP of London, Ontario; Sutts, Strosberg LLP of Windsor, Ontario; Camp Fiorante
Matthews Mogerman of Vancouver, British Columbia; and Belleau Lapointe s.e.n.c.r.l. of Montreal, Quebec.
The “Claims Administrator” is defined as NPT RicePoint Class Action Services Inc. of London, Ontario.
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