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)