1/8/2018 Loblaw Card Program

Loblaw Card Program Online Registration

Registration Submitted: 09/01/2018 Registration ID: Y2C59B9655

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 (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 McGavin's Bread

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

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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: Felicia Lim

2. DATE OF BIRTH: 12/1/1994
3. RESIDENTIAL ADDRESS:
42 HIDDEN CLOSE NW
CALGARY, AB T3A5P8
4. CONTACT INFORMATION:
Mobile: (587) 717-1708
Email: flick.94@hotmail.com

D. VERIFICATION
Please check all boxes that apply to you.

I understand, confirm and agree that:

The Program Administrator may contact me as the Program Administrator deems appropriate for more
information about my registration, including requesting appropriate forms of ID;

I have provided my legal name, current residential address, and correct date of birth in Section C above;
and

I have purchased one of the packaged bread products from one of the eligible banner stores (as
described in Section B above) in the period between January 1, 2002 and March 1, 2015.

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.

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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

By checking this box and typing my name below, I confirm that I have read and understood the
Registration Form and have read, voluntarily accepted and agreed to the Release in Section E, above,
the Loblaw Card Cardholder Agreement and the Program Privacy Policy. I also confirm that the
information I have provided on this form is true, correct, and complete.

09/01/2018 Felicia Lim

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

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