Reclamation Form 1. IDENTIFICATION First name* Last name* Please upload a copy of a proof of photo identification: Maximum 20MB. Accepted file types: .jpg, .png, .gif, .bmp, .pdf 1.1 To be completed ONLY if you have changed your name since the arrest First name at the time of arrest: Last name at the time of arrest: Please provide proof of name change Maximum 20MB. Accepted file types: .jpg, .png, .gif, .bmp, .pdf 1.2 If you are an heir of a member of the collective action Please provide a death certificate of the member Maximum 20MB. Accepted file types: .jpg, .png, .gif, .bmp, .pdf Please provide a proof that you are their heir Maximum 20MB. Accepted file types: .jpg, .png, .gif, .bmp, .pdf 2. CONTACT INFORMATION Address* Apartment City* Province*: —Please choose an option—QuebecOntarioAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutPrince Edward IslandSaskatchewanYukon Postal Code Email address* Phone numbers: Fixed line Cell phone Work phone Occupation 3. DETAILS OF THE INCIDENT GIVING CAUSE TO THE LITIGATION Check the statement that describes your situation*: I was arrested or detained via a surrounding action by the Police services of the City of Montreal on the 1st of May 2014 at 6pm at the intersection of Papineau avenue and Ontario street in Montreal.I was arrested or detained via a surrounding action by the Police services of the City of Montreal on the 1st of May 2014 at 6:45 pm in front of 1385, Sainte-Catherine street East in Montreal.I was arrested or detained via a surrounding action by the Police services of the City of Montreal on the 1st of May 2014 at 7:45 pm next to the Palais des Congrès, in Montreal.I was arrested or detained via a surrounding action by the Police services of the City of Montreal on the 15th of March 2015 on Berri street, close to the viaduct on Sherbrooke street, in Montreal. I acknowledge that only completed forms, including the necessary documents, will be considered. Please ensure that you attach the following documents: - Completed form - Copy of photo identification - If applicable, proof of name change - If applicable, proof that you are an heir. By signing this form I attest that all the information provided is true and accurate. Date* Signature* (please type your full name) You can review the agreement, judgement and notice for the CLASS ACTION AGAINST THE CITY OF MONTREAL REGARDING SEVERAL DEMONSTRATIONS HELD THE 1st OF MAY 2014 AND THE 15th OF MARCH 2015 by clicking here.