50/50 Winner's Form — Laval Rocket

You’re receiving this link because you recently won the 50/50 raffle from the Montreal Canadiens Children’s Foundation. Details of your prize have already been communicated to you by telephone or email.

To receive your prize, you must complete the form below and provide a void check so that we can issue your payment via e-transfer.

For any questions, please contact us at [email protected] and we will get back to you as soon as possible.

Winner's contact information
Name*
First name Last name
Phone number*
E-mail*
Postal address*
Nº and street name Apt. City Postal code
Province / State
Country*
Birth date*
YYYY slash MM slash DD
Preferred language of correspondence*
Liability release
Please read the following conditions and check each box to confirm that you accept the following statements:*
- I understand that I must accept the prize as awarded and it cannot be exchanged or transferred. In return for the prize, I consent that my name, city of residence, photograph, image and/or voice be used, if necessary, at the sole discretion of the Montreal Canadiens Children’s Foundation, the Montreal Canadiens, the Groupe CH and all its entities in all publicity related to the 50/50 program, without any form of compensation or remuneration.
- I understand that in order to claim my prize, I must have provided and completed all the required information within fourteen (14) business days. I understand that by failing to provide all the necessary information within the set time limits, a new winning number will be drawn the next business day.
- I commit myself to releasing any responsibility to the Montreal Canadiens Children’s Foundation, the Montreal Canadiens, the Groupe CH and their respective advertising and promotional agencies, in the case of complaints, claims, damage, legal proceedings or unspecified reasons for legal proceedings being able to be pled against them or one of them, now and thereafter, by myself, my heirs, the will executors or administrators relative with the 50/50 program.
By checking the following boxes, I hereby declare that:*
- I have read, understood, have adhered, and will continue to adhere to all the rules of the said draw and agreed to the above mentioned conditions;
- I am not an employee, agent or representative of Montreal Canadiens Children’s Foundation nor do I reside with one of those persons;
- This declaration is a veracious and precise statement of facts mentioned.
Please indicate your full name and the date on which you completed this declaration.*

Full name
Date*
YYYY slash MM slash DD
Pieces of identification (ID)
Please upload a photo or scan of your winning ticket.*
Max. file size: 300 MB.
Please upload photos or scans of two (2) valid pieces of ID, showing your name and date of birth, with at least one (1) that includes a photo.*
Drop files here or

Max. file size: 300 MB, Max. files: 6.
For example, you can submit a copy of your passport, driver's license, health insurance card, birth certificate, Secure Certificate of Indian Status (SCIS), or any other official document issued by a federal or provincial authority, or a territorial or state government, to confirm your identity.
Banking information
Your prize will be paid to you by bank transfer in Canadian dollars ($CAD) within 60 business days of claiming the prize.
PLEASE UPLOAD A PHOTO OR ELECTRONIC VERSION OF YOUR VOID CHECK.*
Drop files here or

Max. file size: 300 MB.
Make sure the document contains the name of the account holder, your branch address, transit number, institution number, and your account or folio number.
Testimony
Finally, for future testimonials, could you describe in a few words what winning this prize means to you, or what you plan to do with the amount you will receive?

50/50 Winner's Form — Laval Rocket

Winner's contact information

Liability release

Pieces of identification (ID)

Banking information

Testimony