1-888-770-6892
ird@velvetpayments.com
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CIBC Mortgages Prepayment
Charge (IRD) Settlement
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CLAIM FORM
CLAIMANT CONTACT INFORMATION
First Name
(Required)
Last Name
(Required)
Primary Address
(Required)
City
(Required)
Province
(Required)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
(Required)
Email address
(Required to be compensated by e-transfer)
Telephone Number
(Required)
If you are eligible for an indemnity, how do you wish to receive compensation?
(Required)
Interac e-Transfer (by email)
Cheque (by mail)
1. MORTGAGE LOAN INFORMATION
1.1 Who provided your mortgage loan?
(Required)
Select an option
CIBC
Firstline Mortgages
President’s Choice Financial
Other
1.2 Mortgage Start Date or most recently renewed
(Required)
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Do not leave blank. If the exact date is unknown, input approximate date.
1.3 What was your mortgage loan number (if available)?
(Optional)
1.4 Was your mortgage for a fixed-term of 5 years or less at a fixed rate of interest?
(Required)
Yes
No
1.5 Did you pay a prepayment charge?
(Required)
Yes
No
1.6 What was the amount of your prepayment charge?
(Required)
Do not leave blank. If the exact amount is unknown, input approximate amount of your prepayment charge.
1.7 What was the interest rate applicable to your mortgage?
(Required)
Do not leave blank. If the exact rate is unknown, input approximate rate.
1.8 Date the mortgage loan was prepaid
(Required)
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Do not leave blank. If the exact date is unknown, input approximate date.
2. SPECIAL CIRCUMSTANCES (if applicable)
Have you prepaid your mortgage due to Special Circumstances as defined in the Settlement, namely due to (check off the appropriate box, if any)?
(Optional)
2.1 The death of a co-borrower, as documented by a certificate of death;
2.2 The divorce of the borrower from a co-borrower, as documented by a certificate of divorce; and/or
2.3 An incapacitating illness limiting the earning capacity of the borrower or co-borrower, as documented by a medical certificate or a certificate issued by an employer, an insurer or a governmental organization.
Where any of the above Special Circumstances occurred between the date of signature of your mortgage loan for which eligible Prepayment Charges were paid and
within 36 months
prior to the date of prepayment of that same mortgage loan.
If you want to qualify as having experienced Special Circumstances, you must provide the above-mentioned certificate with this Claim Form.
3. SUPPORTING DOCUMENTATION (including discharge statement) (Optional, except in the case of Special Circumstances)
Drag supporting documentation here
4. CLAIM CERTIFICATION & RELEASE
To obtain compensation under the Settlement, you must attest to the following certification:
I am a member of the Class or the authorized representative of a Class Member or Class Member's estate that is a member of the Class.
I confirm that all of the information in this Claim Form is true and correct.
I understand that by submitting this claim, I am authorizing the Claims Administrator to contact me or my representative as the Claims Administrator deems appropriate for more information and/or to audit my claim.
If Special Circumstances apply: I confirm that I had to prepay my mortgage due to one of the Special Circumstances mentioned above
Date:
Full name (in lieu of signature):
(Required)
Submit Claim
If you have any questions while completing the Claim Form please contact the Claims Administrator at:
Velvet Payments
5900 Andover Ave.
Suite 1
Montreal, Quebec
H4T 1H5
ird@velvetpayments.com
1-888-770-6892
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