Claim Form

Part 1 Claimant Name

Persons under the age of 18 are not permitted to file a claim, but their purchases can be claimed by a member of their household who is 18 or older. The individuals under 18 must be listed as Household Members below.


Part 2 Household Members

If you are filing this claim on behalf of a household, please enter the first and last name of each member of your household. Only one claim may be filed for each LCD Product purchased by a household.

You may add multiple names by clicking "Add Name" after each entry is completed.


Part 3 Mailing Address
-

Part 4 Email Address

Part 5 Telephone

Please provide at least one phone number


Part 6 Purchase Information

List all LCD Products you purchased in Canada between January 1, 1998 and December 11, 2006. You must complete every field for each purchase you list. You may add multiple purchases by clicking "Add Purchase" after each entry is completed.

  1. * Purchased from a Defendant? Did you purchase the LCD Product directly from LG, Samsung, Hitachi, Sharp, Toshiba, AU Optronics, HannStar, or Chi Mei? You can still claim even if you purchased your product from another company, and even if it has a different brand name.
    Yes No Unsure
  2. * List the Net Purchase Amount you paid for the product. This is the amount you actually paid for the LCD Product. Do not include rebates, discounts, shipping charges, and taxes.

    If you do not know the amount please see FAQ #15.


Part 7 Upload Your Proof of Purchase

If you received a cover letter:

  • You do not have to provide proof of purchase for any purchases disclosed in your cover letter and prepopulated above.
  • If you are claiming for purchases not disclosed in your cover letter and prepopulated above, please be aware that you can only claim in respect of two undocumented purchases in total. If you are claiming for more than two undocumented purchases, you must provide proof of purchase for any purchases not disclosed in your cover letter and prepopulated above.
If you did not receive a cover letter, you may claim for up to two undocumented purchases. You must provide proof of purchase for any additional purchases.

Proof of purchase includes receipts, model number, product registration, rebate documents or any other documents that support the purchase. See paragraph 28 of the Distribution Protocol available here for more examples of acceptable forms of proof of purchase.

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

If you are unable to provide proof of purchase or the proof of purchase does not state the value of your LCD purchase, your LCD purchase will be valued as follows:

  • LCD televisions - $1,500
  • LCD monitors - $700
  • LCD notebook computers - $2,250
  • LCD panels $640

Uploaded Files


Part 8 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 9 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 10 How do you wish to receive payment?
*I would like to receive my settlement amount, if any, via:
Cheque
Email Transfer

Part 11 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.

Please review all information before submitting your claim.