Krommenhock v. Post Foods, LLC Your Claim Form Must Be Postmarked On PO Box 671 or Before 05/19/2021 Baton Rouge, LA 70821
Krommenhock v. Post Foods, LLC United States District Court for the Northern District of California (Case No. 16-cv-4958-WHO) Added Sugar Class Action Claim Form SAVE TIME AND SELECT YOUR PREFERRED PAYMENT METHOD - Submit online at www.AddedSugarClassAction.com GENERAL CLAIM FORM INFORMATION This Claim Form is for all persons that bought certain varieties of the following Post brand cereals for household use, and not for resale or distribution, between August 29, 2012 and November 2, 2020: • Honey Bunches of Oats • Great Grains • Post Raisin Bran • Post Bran Flakes • Honey Bunches of Oats Granola • Post Selects – Blueberry Morning • Honeycomb • Shredded Wheat • Alpha-Bits • Waffle Crisp • Golden Crisp A complete list of the Post cereals included in the Settlement is located in Apendix 1 on page 3 of this Claim Form. You must complete this Claim Form to be eligible for compensation under the Settlement. Class Members who submit a valid Claim Form by May 19, 2021 are entitled to compensation. Each timely, valid claimant will receive a payment based on the type and estimated amount of Class Products purchased during the Class Period. Submit only one (1) Claim Form per household. TO SUBMIT A CLAIM FOR PAYMENT: 1. Complete all sections of this Claim Form. 2. Sign the Claim Form. 3. Provide proof of purchase, if required in Section 2. 4. Submit the completed Claim Form to Class Administrator by May 19, 2021. This Claim Form should only be used if a claim is being mailed and is not being filed online. You may go to www.AddedSugarClassAction.com to submit your claim online, or you may submit the Claim Form by mail to the address at the top of this form. Section 1: Claimant Information
First Name Middle Initial
Last Name Suffix
Street Address
Apt/Floor/Suite
City State Zip Code
Email Address (Required) ( ) - Phone Number
QUESTIONS? VISIT WWW.ADDEDSUGARCLASSACTION.COM OR CALL TOLL FREE 1-844-970-1302 Added Sugar Class Action Claim Form Section 2: Purchase Information Instructions In the appropriate boxes below, enter the approximate number of purchases you make over a typical three-month period and the year that you began purchasing the product. A complete list of the Post cereal varieties included in the Settlement is located in Apendix 1 on page 3 of this Claim Form. There is a limit of 4 boxes per month for each class product unless you submit proof of purchase. There is no limit for claims that provide proof of purchase. Proof of purchase may be in the form of receipts, purchase orders, invoices, or other documents indicating the product purchased, date of purchase, and quantity purchased. Failure to provide sufficient proof of purchase may result in your claim being subjected to the 4 box per month product cap or denied by the Class Administrator. Proof of purchase, if any, must be submitted concurrently with your claim submission. The Class Administrator is not required to notify you of any defect with your proof of purchase. Boxes Purchased Per 3 Months Year that you began to purchase Product (on Average) this product
Raisin Bran
Honey Bunches of Oats*
Bran Flakes
Selects
Great Grains*
Shredded Wheat: Honey Nut OR Crunch!**
Alpha-Bits
Golden Crisp
Honeycomb
Waffle Crisp
Honey Bunches of Oats Granola
Is Proof of Purchase included with your claim submission? YES NO
*For the full list of varieties of this product included in the Settlement, please review Appendix 1 on page 3 of this Claim Form **Do NOT include your purchases of regular Shredded Wheat, it is not considered an eligible product under the terms of this Settlement. Section 3: Certification I declare that all of the information on this claim form is true and correct to the best of my knowledge. I understand that my claim from may be subject to audit, verification, and Court review. Signature: Date: / / 2 0
REMINDER CHECKLIST 1. Complete all sections of this Claim Form. 2. Sign and date the Claim Form in Section 3. 3. Enclose Proof of Purchase documentation if you have claimed more than 4 products per month for any of the Class Products. 4. Mail your completed Claim Form to the Settlement Administrator or submit your claim online at www.AddedSugarClassAction.com. Please keep a copy of your completed Claim Form for your records. 5. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form. You can update your contact information at www.AddedSugarClassAction.com.
QUESTIONS? VISIT WWW.ADDEDSUGARCLASSACTION.COM OR CALL TOLL FREE 1-844-970-1302 Appendix of Class Products Product Flavors / Variations Box Sizes 20 oz. Raisin Bran NA 25 oz. Bran Flakes NA 16 oz. Selects [Discontinued after 2016] Blueberry Morning 13.5 oz. 13.5 oz. Blueberry Morning 14 oz. Cranberry Almond Crunch 14.75 oz. Banana Nut Crunch 15.5 oz. Raisin Dates & Pecans 15.9 oz. Great Grains Crunchy Pecans 16 oz. Blueberry Pomegranate 17 oz. Protein Blend: Honey, Oats & Seeds 19 oz. Protein Blend: Cinnamon Hazelnut 20.8 oz. 40.5 oz. 2.25 oz. 4.3 oz. 12.25 oz. 12.5 oz. Honey Roasted 13 oz. Almonds 14 oz. Raisin Medley 14.5 oz. Pecan Bunches 14.75 oz. Cinnamon Bunches 15 oz. Vanilla Bunches 15.5 oz. Apples & Cinnamon Bunches 16 oz. Real Strawberries 16.5 oz. Real Peaches 17 oz. Honey Bunches of Oats Fruit Blends Banana Blueberry 18 oz. Fruit Blends Peach Raspberry 19.5 oz. Tropical Blends Mango Coconut 20 oz. Whole Grain with Vanilla Bunches 23 oz. Whole Grain Honey Crunch 24.5 oz. Greek Honey Crunch 27 oz. Greek Mixed Berry 28 oz. Morning Energy Cinnamon Crunch 30.5 oz. Morning Energy Chocolatey Almond 35.5 oz. Crunch 36 oz. 39 oz. 40 oz. 48 oz.
Honey Roasted 10 oz. Honey Bunches of Oats Granola Raspberry 11 oz. Cinnamon 20 oz.
3
Product Flavors / Variations Box Sizes Protein Dark Chocolate 18.25 oz. Shredded Wheat [Discontinued Honey Nut 19 oz. after 2018] Crunch! 20 oz. 1 oz. 11.5 oz. Alpha-Bits NA 12 oz. 18 oz. 14.75 oz. 17 oz. 23 oz. Golden Crisp NA 29.5 oz. 30 oz. 39.5 oz. 12.5 oz. 16 oz. Honeycomb NA 25 oz.33 oz. 35 oz. 35.5 oz. Waffle Crisp NA 11.5 oz.
4