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 as part of a Laval Rocket game at Place Bell. 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 Last
Phone number*
Email*
Address*
Street number and name Apt. City Postal code
Province / State
Country*
Date of birth*
YYYY slash MM slash DD
Preferred language of communication*
Are you a season ticket holder?*
- Yes
- No
Exoneration of responsability
Please read and check the following conditions to confirm that you accept each of these 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 Laval Rocket, 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 two (2) 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 Laval Rocket, 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 write your full name and the date this form was filled out at. *

Full name
Date*
YYYY slash MM slash DD
Identification
Please upload a photo or scan of your winning ticket.*
Max. file size: 300 MB.
Upload pictures or scans of two (2) valid identity documents that include your name and your date of birth, including at least one (1) with a photo. *
Drop files here or

Max. file size: 300 MB, Max. files: 6.
For example, you could upload a copy of either your passport, your driver's licence, your health insurance card, your birth certificate, your certificate of Indian status, or other official documents issued by a federal, provincial, territorial or state government authority allowing us to confirm your identity.
Banking information
Your prize will be paid by direct deposit in Canadian dollars ($ CAD) within 60 business days of claiming the prize.
PLEASE UPLOAD A PHOTO OR THE ELECTRONIC VERSION OF A VOIDED CHECK.*
Drop files here or

Max. file size: 300 MB.
Make sure that the document you upload contains the name of the account holder, the address of your branch, the transit number, the financial institution number, as well as your account (or folio) number.
Testimonials
Lastly, for future testimonials, could you describe in a few words what winning this prize means to you, or what you intend to do with the amount that you will receive?

50/50 Winner's Form — Laval Rocket

Winner's contact information

Exoneration of responsability

Identification

Banking information

Testimonials