To make a claim under the Settlement, you must complete this form by 11:59 pm PT on March 19, 2019. The information will not be disclosed to anyone other than the Court, the Settlement Administrator, and the Parties in this case, and will be used only for purposes of administering this Settlement (such as to audit and review a claim for completeness, truth, and accuracy).
You can submit a Claim for a Benefit Check under this Settlement if you purchased any Canada Dry Ginger Ale Products in the United States, between January 1, 2013, and December 19, 2018, which contained the terms “Made from Real Ginger” on the labels, including those listed in the Petition.
Before you complete and submit this Claim Form, you should read and be familiar with the Settlement Notice (“the 49-State Notice”) available on this website. Defined terms (with initial capitals) used in these General Instructions have the same meaning as set forth in the respective Settlement Agreement for each Settlement. By submitting this Claim Form, you acknowledge that you have read and understand the 49-State Notice for the Settlement at issue, and you agree to the Release(s) included as a material term of the Settlement Agreement.
If you fail to timely submit a Claim Form, you may be precluded from any recovery from the Settlement fund. If you are a member of the Settlement Class and you do not timely and validly seek to Opt-Out from the Settlement Class, you will be bound by any judgment entered by the Court approving the Settlement regardless of whether you submit a Claim Form. You can elect one Benefit per Household.
Settlement Class Members who seek payment from the Settlement must complete this Claim Form. Claim Forms must be SUBMITTED ONLINE NO LATER THAN MARCH 19, 2019 at 11:59 p.m., Pacific Time.
District of Columbia
Did you purchase Canada Dry Ginger Ale Products solely in the state of California between December 28, 2012, and the present?
Please select which Tier you believe is applicable to your claim
Tier 1 Benefit is available for Settlement Class Members who purchased Canada Dry Products during the Class Period and do not have a valid Proof of Purchase. You may receive a Benefit of $0.40 per Unit purchased, up to 13 Units, for a
maximum of $5.20 per Household. You may receive a minimum payment of $2.00 per eligible Household. Settlement Class Members, however, could receive less than $0.40 per Unit or the $2.00 minimum payment, depending on a number of factors, including how many Valid Claims are actually submitted.
1. Please identify the Canada Dry Product(s) you purchased.
2. How many Unit(s) did you purchase?
3. Approximate month(s) and year(s) of purchases:
Month of Purchase
Year of Purchase
4. Please identify the store(s) where you purchased the products: (Optional)
Tier 2 Benefit is available for Settlement Class Members who purchased the Products during the Class Period and have a valid Proof of Purchase. You may receive up to a maximum of $0.40 per Unit, up to a
maximum of 100 units or $40.00 per Household. However, the maximum amount could be less than $40.00, depending on a number of factors, including how many Valid Claims are actually submitted.
1. Please attach Proof(s) of Purchase.
Submission to Jurisdiction of the Court
By signing below, you are submitting to the jurisdiction of the Circuit Court of the City of St. Louis, State of Missouri.
* I hereby affirm, under penalty of perjury, that the information I have provided in this Claim Form is true and correct to the best of my knowledge and this is the only Claim Form that I have submitted.