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F O R O FFI C I A L U S E O N LY In re M3Power Razor System Marketing & Sales Practices Litigation Civil Action No. 05-11177 (Lead Case) United States District Court for the District of Massachusetts

C L AIM FORM LIMITED TO ONE PER PERSON, AND THREE PER HOUSEHOLD MUST BE POSTMARKED NO LATER THAN MAY 2, 2011 and SENT TO EITHER: M3POWER SETTLEMENT P.O. BOX 2302 FARIBAULT, MN 55021-9002

M3POWER SETTLEMENT P.O. BOX 1051 FORT ERIE, ON L2A 6C7

-or-

A . NAME AND ADDRE S S: First Name:

Middle Initial:

Last Name:

State/Province:

Zip Code/Postal Code:

Mailing Address: City/Town:

B. C ER T IFIC AT ION: BY SIGNING BELOW, I CERTIFY THAT I LIVE IN THE UNITED STATES OR CANADA, AND THAT I ACQUIRED FOR USE AND NOT RESALE AN M3POWER RAZOR (CHECK ONE):

IN THE UNITED STATES BETWEEN MAY 1, 2004 AND SEPTEMBER 30, 2005, OR

IN CANADA BETWEEN MAY 1, 2004 AND OCTOBER 31, 2005.

I ALSO HEREBY CERTIFY THAT I AM NOT SUBMITTING ANY OTHER CLAIM FOR A REFUND, REBATE, OR REPLACEMENT RAZOR.

C . C H O IC E BE T WEEN REFUND OR REBAT E S OR REPL AC EMEN T R A ZOR: CHOOSE EITHER THE REFUND OPTION, OR THE REBATES OPTION OR THE REPLACEMENT RAZOR OPTION. YOU MAY NOT CHOOSE MORE THAN ONE OPTION. REFUND OPTION. I am enclosing the M3Power Razor that I purchased or otherwise acquired.

REBATES OPTION. YES

I am claiming:

(required for this option)

REPLACEMENT RAZOR OPTION. ONE REBATE TWO REBATES

I am electing to receive a new Gillette manual men’s razor.

YES NO

The refund is $13 U.S. or $16.25 Canadian.

The rebates are $5 U.S. each, or the equivalent in Canadian dollars, on purchase(s) M3Power blades and/or Fusion or Fusion OPTIONAL: To claim a higher refund, you of MUST ALSO submit a receipt for the M3Power ProGlide razors (manual or battery powered). Razor showing that the price paid was more You MUST enclose the UPC code or a than $13 US or $16.25 Canadian. receipt for each purchase to claim a rebate. You cannot receive two rebates on the purchase of a single item. See the Notice of Class Action Settlement for details, available at www.m3powersettlement.com or by calling 1-877-506-4030.

D. I DEC L ARE UNDER PENALT IE S OF PER JURY T HAT T HE ABOVE I S T RUE AND CO RREC T. Signature:

*GILL*

: :

Date:

*1-1*


rebate claim form