Claim Form -Canada Superior Court. Province Of Quebec, Montreal.

C A N A D A

SUPERIOR COURT

(Class Action Chamber)

PROVINCE OF QUEBEC

DISTRICT OF MONTREAL

REGROUPEMENT DES COMITÉS LOGEMENT ET ASSOCIATIONS DE LOCATAIRES

: 500-06-000403-077

DU QUÉBEC

Plaintiff

And

DENISE GAUTHIER

Designated Member

SOCIÉTÉ D’HABITATION DU QUÉBEC

Defendant

CLAIM FORM

the undersigned, domiciled at

______________________

(First name and last name)

(full current address)

solemnly, sincerely and truly affirm, and declare that:

I am a member belonging to one of the groups of the present class action. I was a recipient of the Rent Supplement Program or of the Rent

Supplement Emergency Program. I was subject to a subsidy reduction by the Société d’habitation du Québec which added a monthly charge to

my contribution to the rent in exchange for a stove or refrigerator included in my lease for a minimum of one month since July, 1

2004.

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Parent category: Legal