Submit a Claim

Part ICommunication

Preferred method of communication*

The Claims Administrator will send your Acknowledgment Letter by this method.

Part IIIdentification

Section 1 – Claimant Identification

I am filing this claim on behalf of*

Myself

A minor (under the age of 18)

A person under legal disability

A deceased person

Personal information

If you are a lawyer or representative completing this form on behalf of your client, please complete both this Section and Section 3.

Claimant's First Name*

Last Name*

Date of Birth*

Date of Death (if applicable)

Address & contact details

Email Address*

We'll send an email verification code and your claim confirmation email here.

Phone (home)*

Phone (work)

Health Insurance Number*

Address*

Apartment

Country*

City*

Province / State*

Postal Code*

Section 2 – Representative Identification

Complete this Section only if you are submitting a claim as a representative of a Claimant or minor(s). You must provide proof of your authority to act.

I'm a representative completing this for the ClaimantCheck this to enable the fields below.

Representative's First Name

Last Name

Representative's Email Address

We'll send an email verification code and your claim confirmation email here.

Address

Apartment

Country

City

Province / State

Postal Code

Phone (home)

Phone (work)

Section 3 – Legal Representative Identification

Complete this Section only if a lawyer or agent represents the Claimant. All subsequent correspondence will be forwarded to your legal representative.

If you have had the assistance of Class Counsel (LPC Avocats: Mtre Joey Zukran / Mtre Léa Bruyère) you do not need to complete this section.

Add a lawyer or agent to be copied on all communications about this claim

Name of Law Firm

Attorney's or Agent's Email Address

Attorney's or Agent's First Name

Last Name

Address

Country

City

Province / State

Postal Code

Phone

Fax

Part IIIProof of Purchase and Ingestion (Exposure)

For the purposes of this Claim Form, "Recalled Product" refers to Silk Products and Great Value Products recalled Products, as comprehensively listed in Schedule "B". This definition encompasses all Silk Products and Great Value Products that were voluntarily recalled by Danone Canada, with the recall process initiated on July 8, 2024, with the best-before dates and 4-digit product code (7825) listed in Schedule "B".

1. Please provide details as to the Primary Claimant's purchase of the Recalled Product:

(a) Where was the Recalled Product purchased? (retailer name and city/province)

(b) What Recalled Product(s) were purchased? (ex: brand, product name, flavor)

(c) When was the Recalled Product purchased? (Year and approximate month)

Year

Month

(d) Did you retain any packaging showing the best-before date and 4-digit product code 7825 on the top of the carton?

(e) Do you have proof of purchase (receipt, bank/credit card record) or retained packaging corroborating purchase?

(f) Do the records refer to a Recalled Product listed in ?

2. If you are the Primary Claimant that purchased the Recalled Product but do not have such purchase or packaging records, and if (and only if) the illness event(s) occurred within the relevant incubation window (at least 48 hours and no more than 70 days after consumption), please check the box below as your solemn declaration attesting to said purchase and that these documents are not available;

Yes

3. Please provide details regarding the Primary Claimant's ingestion of the Recalled Product:

(a) Do you affirm that the Primary Claimant consumed a Recalled Product?*

(b) When did the Primary Claimant consume the Recalled Product? (Year and approximate month)

Year

Month

Part IVProof of Illness (Listeriosis or Related Harm)

For the purposes of this Claim Form, "Medical Records" means medical reports, physician notes, hospital admission records, lab results including culture/PCR, discharge summary, blood test results or other medical documents created during or shortly after an Illness by a physician, a hospital or any other health professional in Canada.

If the claim is for a Primary Claimant with symptoms that lasted more than one week as a result of consuming the Recalled Products, you must provide contemporaneous Medical Records containing a diagnosis of Listeriosis or evidence of symptoms consistent with Listeriosis or evidence of psychological disorder following the consumption of the Recalled Product.

4. How many hours or days after consuming the recalled product did symptoms consistent with Listeriosis begin to develop?*

5. State the nature of symptoms:*

(a) Length of the symptoms and complications:*

up to 48 hours

more than 48 hours up to one week

more than one week without hospitalization

more than one week and was hospitalized but did not develop complications or permanent symptoms

more than one week and was hospitalized and developed severe complications and/or permanent symptoms

(b) Do you have contemporaneous Medical Records containing a diagnosis of Listeriosis or evidence of symptoms consistent with Listeriosis*

(c) If available, provide Whole Genome Sequencing (WGS) or other laboratory confirmation relating to Listeria monocytogenes.*

Was the Primary Claimant hospitalized?*

6. If the Primary Claimant was hospitalized, please state the:

Answer "Yes" above if the Primary Claimant was hospitalized to add the visit details.

7. Did the Primary Claimant die as a result of the Illness event(s)?*

This section applies only when filing on behalf of a deceased person. Change the claimant type in Part II.

(a) If so, when?:

(b) Do you have the Primary Claimant's death certificate?

(c) Do you have at least one medical record stating that the death was caused by Listeriosis (or complications thereof)?

(d) Alternatively, if such a record existed but has now been destroyed, do you have a signed note from a physician who was involved in the Primary Claimant's care or treatment stating that the Primary Claimant experienced Listeriosis (or qualifying Illness) that resulted in the Primary Claimant's death?

8. Did the Primary Claimant receive a new diagnosis of a medically recognized psychological disorder following the consumption of the Recalled Product with symptoms that are more acute than upset, disgust, anxiety, insomnia or agitation?*

(a) If so, what was it?

(b) Do you have medical records stating that the Primary Claimant received a new diagnosis of a medically recognized psychological disorder following the consumption of the Recalled Product?

9. Did the Primary Claimant develop severe complications and / or permanent symptoms?*

(a) If so, what were they?

(b) Do you have medical records stating that the Primary Claimant developed symptoms consistent with Listeriosis, and Listeriosis caused the Primary Claimant to develop severe complications or permanent symptoms?

Part VFamily ClaimantsFamily Claimants are eligible for compensation only if the Primary Claimant qualifies under Tier V or Tier VI of the Compensation Grid.

10. If you are a Family Claimant or are making a Claim on behalf of one or more Family Claimants, please state the names and addresses of each and their relationship to the Primary Claimant.

No Family Claimants added yet.

11. Please confirm that you have submitted the required documentation to support the relationship of each Family Claimant listed above and proof of address. You must submit the required documentation on behalf of each Family Claimant. Check all that apply.

Please note that the terms “Proof of common address” used hereafter refer to the proof of residency and cohabitation of the Family Claimant and the Primary Claimant required for each Family Claimant over 18 years old, or, proof of residency and cohabitation of the Family Claimant's guardian attesting to the cohabitation of the Family Claimant and the Primary Claimant required for each Family Claimant over 18 years old.

Add a Family Claimant above to see the documentation required for them.

Part VISpecial DamagesSpecial Damages are eligible for compensation only if the Primary Claimant qualifies under Tier V or Tier VI of the Compensation Grid.

12. Are you making a claim for Special Damages (such as medical expenses, out-of-pocket expenses for transportation, funeral expenses)?*

13. If so, do you have each of the following to demonstrate that the Primary Claimant incurred special damages?

(a) Proof of expenses (such as medical expenses, out-of-pocket expenses for transportation, funeral expenses)

(b) Proof of payment of the expenses

(c) Describe the document(s) and amount(s) paid

No entries added yet.

Part VIIRelease for Claim

14. Did the Primary Claimant or you receive compensation under other proceedings or another settlement and/or have given a release relating to the Recalled Products?*

(a) If the Primary Claimant or you have been compensated or have given a release for your claims, please provide the details required below:

(i) Name of the Primary Claimant:

(ii) Compensation amount:

$

(iii) Details of released claims:

Part VIIIGuardian's Acknowledgment of Responsibility

This section is only required when filing on behalf of a minor. Go to Section 1 and select 'A minor (under the age of 18)' to enable it.

15. Please complete this acknowledgment for each minor claimant mentioned in this form.

This Acknowledgment of Responsibility is given by:

Guardian's Name

Guardian's Email Address

Address

Apartment

Country

City

Province / State

Postal Code

Phone (home)

Phone (work)

(a) This acknowledgment of responsibility relates to the minor:

Name of minor

Date of birth (DD/MM/YY)

(b) I am the guardian of the minor because I am:

the minor's parent.

the guardian appointed by the deed or will of the minor's parent,

(name of deceased parent)

the guardian appointed by a court order dated

(date of guardianship order)

(c) I have the power and responsibility to make day-to-day decisions affecting the minor.

(d) I have uploaded, or will upload, a copy of my authority to act on behalf of the minor (e.g., long-form birth certificate, baptismal certificate, court order, or other proof of guardianship).

Guardian's authority to act

Required document — upload now or provide before October 16, 2026.

(e) I request that the Claims Administrator deliver to me, to hold as trustee for the minor, money payable to the minor pursuant the settlement.

(f) I will use or expend the money for the benefit of the minor in conformity with the laws in my jurisdiction.

Date

Guardian's Name in Lieu of Signature

Part IXClaimant Declaration and Authorization

16. To submit a claim, you must affirm to the truth of the contents of this Claim Form and any subsequent amendments or supplements thereto. The contents of this form have been approved by the Superior Court of Quebec, and making a false statement may be considered perjury by which you may be penalized by disallowance of your claim and/or prosecution.

(a) Do you affirm that the information in this Claim Form is true to the best of your knowledge?*

17. Payment method (if your claim is approved)

Payment method*

Date Submitted:

Acceptance of Claimant (in lieu of signature)*

Final stepDocuments

This is a checklist of the supporting documents implied by your answers. You can attach them now or submit them later — your claim can be filed before the documents are approved.

Based on your answers so far, no supporting documents are required for this claim.

Claim Form

Claim Form

Section 1 – Claimant Identification

Personal information

Address & contact details

Section 2 – Representative Identification

Section 3 – Legal Representative Identification

1. Please provide details as to the Primary Claimant's purchase of the Recalled Product:

3. Please provide details regarding the Primary Claimant's ingestion of the Recalled Product:

6. If the Primary Claimant was hospitalized, please state the:

This Acknowledgment of Responsibility is given by:

(a) This acknowledgment of responsibility relates to the minor:

17. Payment method (if your claim is approved)

Acknowledge and submit

Before you submit, please read and agree