Claim Form

Part 1 Company Info

Part 2 Mailing Address
-

Part 3 Additional Business or Trade Names, or Addresses

If between 1998 and 2006, you changed business or trade names and/or addresses, please list the previous names and/or addresses below.

You may add multiple companies by clicking "Add Company" after each entry is completed.


Part 4 Claims on Behalf of Related Entities

If you are including LCD Products purchased by or on behalf of corporate entities that the company owns or controls, list the name and address of each entity and attach proof of ownership or control. Only one claim may be filed for each LCD Product purchased. Such entities will not be permitted to file a claim in respect of the same LCD Products.

* I am / am not filing on behalf of a related entity.


Part 5 Email Address

Part 6 Telephone

Please provide at least one phone number


Part 7 Purchases from Defendants

Please summarize all LCD Products purchased in Canada between January 1, 1998 and December 11, 2006 direct from the Defendants (listed below) or an entity related to a Defendant. You should also include LCD Products that were purchased from another entity, but the purchase price was negotiated directly with a Defendant or an entity related to a Defendant.

  • LG Display Co., Ltd., LG Display America, Inc.
  • Samsung Electronics Co. Ltd., Samsung Electronics Canada Inc.
  • Hitachi Ltd., Hitachi Displays,Ltd., Hitachi Canada, Ltd., Hitachi America Ltd., Hitachi Electronics Devices (USA) Inc.
  • Sharp Corporation, Sharp Electronics Corporation, Sharp Electronics of Canada Ltd.
  • Toshiba Corporation,Toshiba Matsushita Display Technology Co., Ltd., Toshiba America Corporation, Toshiba of Canada Limited
  • AU Optronics Corp., AU Optronics Corporation America
  • Chi Mei Optoelectronics Corporation, Chi Mei Corporation, Chi Mei Optoelectronics USA, Inc, Chi Mei Optoelectronics Japan Co., Ltd., Nexgen Mediatech, Inc.
  • HannStar Display Corporation
  • Chunghwa Picture Tubes, Ltd.
  • Epson Imaging Devices Corporation (formerly known as Sanyo Epson Imaging Devices Corporation)

Chart A - Purchase Summary

The purchase price is the net amount actually paid for the LCD Products. Do not include rebates, discounts, trade promotions, shipping, taxes, etc.

Edit
Notebook
Computers
LCD
Monitors
LCD
Televisions
LCD
Panels
(10" or larger)
AU Optronics America
defendants
$ $ $ $
Chi Mei/Innolux
defendants
$ $ $ $
Chughwa defendants $ $ $ $
Epson defendants $ $ $ $
HannStar defendants $ $ $ $
Hitachi/Japan Displays
defendants
$ $ $ $
LG Phillips defendants $ $ $ $
Samsung defendants $ $ $ $
Sharp defendants $ $ $ $
Toshiba defendants $ $ $ $
Grand Total $ $ $ $

Chart B - Purchase Use


Notebook
Computers
LCD
Monitors
LCD
Televisions
LCD
Panels
(10" or larger)
What percentage of your LCD Purchases was for your own use? % % % %
What percentage of your purchases was for commercial resale? % % % %

Part 8 Purchases From Other Entities

Please summarize all LCD Products purchased in Canada between January 1, 1998 and December 11, 2006 from entities other than a defendant. This might include, for example, purchases from a distributor (i.e., Supercom, Comtronic, Ingram Micro, etc.), purchases from an original equipment manufacturer (i.e., Apple, Dell, HP, IBM, Lenovo, etc.), or purchases from a retailer (i.e., Best Buy, Future Shop, etc.).

The purchase price is the net amount actually paid for the LCD Products. Do not include rebates, discounts, trade promotions, shipping, taxes, etc.

Notebook
Computers
LCD
Monitors
LCD
Televisions
LCD
Panels
(10" or larger)
Net Purchase Price $ $ $ $
What percentage of your LCD Purchases was for your own use? % % % %
What percentage of your LCD Purchases was for commercial resale? % % % %

Part 9 Upload Your Proof of Purchase

If you received a cover letter with login credentials:

  • You do not have to provide proof of purchase for any purchases disclosed in your cover letter and prepopulated in the charts above.
  • You must provide proof of purchase for any purchases not disclosed in your cover letter and prepopulated in the charts above.

If you did not receive a cover letter, you must provide proof of purchase for any purchases disclosed above.

Proof of purchase might include receipts, delivery or packing slips, purchase records, historical accounting records or any other documentation that supports the purchase.

Proof of purchase can be uploaded in PDF format. Files cannot be larger than 10MB. You may upload multiple files.

Uploaded Files


Part 10 Release Of Claims

*I verify that I have / have not received compensation through other proceedings or private out-of-class settlements and/or provided a release in respect of my LCD Products Purchases.


Part 11 Consent To Use Information

There are other similar class actions ongoing in Canada relating to computer components. These include optical disc drives and lithium batteries.

We would like to keep information about you and your LCD purchases to make it easier for you to claim in the other class actions, and for us to send you information about them. We will keep your information secure. If you agree, please select "agree" below.

Can we keep your information to help you claim in other similar cases?

I hereby Agree / Do Not Agree to the administrator retaining my information for the sole purposes of facilitating the filing of my claim in the optical disc drives and lithium batteries class actions and providing direct mail or email notice regarding those class actions. I understand that, if another company is appointed as administrator in these class actions, my information will be disclosed to that company and will be used by that company solely for the purpose of facilitating the filing of my claim in the optical disc drives and lithium batteries class actions. I understand that whether I am eligible for compensation as part of these class actions will depend on the specific terms of the settlements achieved and any related court orders. I further understand that whether my information can be used for this purpose is subject to court approval in those class actions.

Can we use your information to send you information about other similar cases?

I hereby Agree / Do Not Agree to the administrator providing my information to Class Counsel solely for the purpose of providing direct mail or email notice of the optical disc drives and lithium batteries class actions. Consent to receiving notice by email regarding the class actions will remain in effect unless or until I withdraw such consent by written request sent to:

Canadian LCD Price-Fixing Class Action Claims Administrator
c/o RicePoint Administration Inc.
PO Box 444
Toronto Station A
Toronto, ON M5W 4B1


Part 12 Payment
You will receive your settlement amount, if any, via cheque.

Part 13 Verification

* I understand that by submitting this claim I am authorizing the Claims Administrator to contact me as the Claims Administrator deems appropriate for more information about my claim.

I agree to allow the Claims Administrator to use the information I have provided for any future LCD Products settlements.

I verify that I am at least 18 years old.

I declare under penalty of perjury under the laws of Canada, that the information provided in this Claim Form is true and correct.

*

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Please review all information before submitting your claim.