A. INSTRUCTIONS FOR COMPLETING THIS FORM

  1. Please read the requirements under Section B before completing this registration form to determine if you are eligible to receive a $25 Loblaw Card. Registering for and obtaining the $25 Loblaw Card will not affect customers’ right to participate in any class action or to receive any incremental compensation that may be awarded by the court.
  2. You do not need to submit ANY documentation with this registration form.
  3. If you wish to submit a registration form, you must:
    1. Fill in all personal information requested in Section C below.
    2. Check all boxes that apply to you in Section D below.
    3. Carefully review the Release in Section E below.
    4. E-sign the registration form under Section F below.

B. ELIGIBILITY TO PARTICIPATE

You are eligible to receive a $25 Loblaw Card:

IF

You purchased one or more of the following brands of packaged bread from Loblaws, Atlantic Superstore, Bloor Street Market, Cash & Carry, Club Entrepôt, Dominion (in Newfoundland & Labrador), Extra Foods, Fortinos, Independent City Market, Loblaws City Market, Maxi, Maxi & Cie, No Frills, Presto, Provigo, Provigo Le Marché, Real Canadian Superstore, Real Canadian Wholesale Club, Valu-mart, Wholesale Club, Your Independent Grocer, or Zehrs in the period between January 1, 2002 and March 1, 2015:

    • Ben's Bread
    • Bon Matin Bread
    • Country Harvest Bread
    • Dempster's Bread
    • D'Italiano Bread
    • Gadoua Bread
    • McGavin's Bread
    • No Name Bread
    • Old Mill Bread
    • POM Bread
    • Weston Bread
    • Wonder Bread

AND

You are of the age of majority, which means 18 years or older if you live in: Alberta, Manitoba, Ontario, Prince Edward Island, Québec, or Saskatchewan.

OR

19 years or older if you live in: British Columbia, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, or Yukon.

See Loblaw Card Cardholder Agreement for card terms and conditions.

Loblaw reserves the right to limit the total number of cards that will be issued under the Loblaw Card Program.

C. PERSONAL INFORMATION

We take your privacy very seriously. We are collecting your personal information to verify your eligibility and communicate with you, as well as to manage fraud, track and prove card activation and use, and protect your personal information. The Program Privacy Policy applies to this collection of personal information.

  1. NAME
  2. DATE OF BIRTH
    This information is necessary to verify your eligibility and manage fraud.
  3. RESIDENTIAL ADDRESS

    Please provide your exact address, since this is where we will send your card.

  4. MAILING ADDRESS

    Is your mailing address different than your residential address?    

  5. CONTACT INFORMATION

    Please let us know how we can reach you. We may contact you to request more information about your registration form. You must provide at least one phone number and an e-mail address.

D. VERIFICATION

Please check all boxes that apply to you.

I understand, confirm and agree that:

E. RELEASE

Please review the Release carefully.

As you may be aware, proposed class actions relating to an overcharge on the price of packaged bread have been commenced. The proposed class actions have not yet been certified by the courts as class actions. If you wish, you may contact one of the intended class action law firms (click here for firm information).

In exchange for this twenty-five (25) Canadian Dollar Loblaw Card you hereby release and forever discharge Loblaw (“Loblaw” includes Loblaw Companies Limited, its parent corporation George Weston Limited and their affiliates as well as all of their current and former officers, directors, and employees) from any and all claims or causes of action (of whatever nature or kind) for damages, costs or other relief that you may have relating to or otherwise in connection with any overcharge on the price of packaged bread in the period between January 1, 2002 and March 1, 2015, to the extent of twenty-five dollars.

Agreeing to this release will not impact your right to participate in any class actions relating to an overcharge on the price of packaged bread. However, doing so will mean that twenty-five (25) dollars will be deducted from any compensation that you may otherwise be entitled to receive in any class action judgment against, or settlement with, Loblaw relating to any overcharge on the price of packaged bread in the period between January 1, 2002 and March 1, 2015.

You may wish to obtain independent legal advice, including by contacting one of the intended class action firms, before checking the box in Section F below, and submitting this Registration Form.

F. CERTIFICATION AND AGREEMENT

In most cases, registrations will be processed and, if approved, cards should be received in the mail within six weeks. In some cases, however, registration processing (including fraud management) and card delivery may take up to 12 weeks.

For further details regarding the $25 Loblaw Card, please visit www.LoblawCard.ca or call the Program Administrator toll-free at 1-855-465-8881.

Loblaw Companies Limited

1 President's Choice Circle, Brampton, ON L6Y 5S5

1-888-495-5111 – www.loblaw.ca