Claim Form

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Claim Form

Were you a cardholder of a Peoples Trust prepaid Visa or Mastercard payment card between November 29, 2011 and April 30, 2014?
If so, you might be affected by a class action settlement totaling $17,000,000.

Instructions

Fill out all information requested below.
Claims are limited to one per individual.
All information must be true and accurate to the best of your ability.
Fields marked with * must be completed.
Incomplete claims will be rejected.

Claimant Information

First Name

Last Name

Primary Address

Primary Address Continued

City

Province

Postal Code

Country

Email Address

Telephone Number

Date of Birth

Prepaid Cards

Were you a Cardholder of one of the following Peoples Trust prepaid Visa or MasterCard payment cards between November 29, 2011 and April 30, 2014:

Please indicate whether you were a cardholder of a single use Non-Reloadable Prepaid Card and/or a general purpose Reloadable Prepaid Card. Then please indicate the specific prepaid card(s) you possessed.

Non-Reloadable Prepaid Cards

Reloadable Prepaid Cards

Did you reside in Ontario at that time? Yes No

Did you acquire and/or use the card for consumer purposes? Yes No

Declaration and Affirmation Under Oath

I declare and affirm under oath that the information stated above is accurate to the best of my knowledge and that I was a Cardholder of a Card on which this claim is based.

Note—It is a Criminal Offence to Make a False Statement.

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