Kumar v. Safeway, Inc. Class Action Settlement

Claim Form

Section 1: Claimant Information
Section 2: Claim Payment Type
Section 3: Claim Purchases Made with Club Cards

Club Cards (Club Account Numbers)

I, or a member of my family is the owner or authorized user of the following Safeway Club Card(s): (Enter 10-digit telephone numbers linked to Club Cards (if known))

OR

Were any of these Safeway Club Cards registered to a different mailing address from the one you entered above?

Yes/Maybe No
Section 4: Claim Additional Purchases If You Have Receipts

Do you have any purchases of the Products that were not made with the above Safeway Club Accounts, which you have receipts for? If Yes, upload the receipts now.

Maximum file size: 30 mb

Allowed file types: .jpg, .jpeg, .tif, .tiff, .gif, .png, .pdf

Uploaded Files

Section 5: Claim Additional Non-Club Card Purchases Without Receipts

Do you have any purchases you would like to claim, that were not made with the above Safeway Club Accounts, for which you do not have a receipt? If you are only making claims for the products shown in your Club Card records or in the store receipts you are attaching, select 'No'.

Yes No
Section 6: Review

Click Continue to review your claim before submitting.

Required