Woolworths Class Action | Register Your Interest

Name*
Prefix First Middle Last
Phone*
Please add country code prefix - for Australia please enter +61 then remove the first 0 of your number (i.e +61400000000)
Email*
Enter Email Confirm Email
Address*
Street Address Suburb City State / Province / Region Post Code Country
Date Of Birth*
Date Format: DD slash MM slash YYYY
Were you employed by Woolworths to work in a salaried supervisory or management position within the last 6 years?*
- Yes
- No

Disclosure Letter

By signing below and submitting this form you:
- reasonably believe that you will be eligible to participate in the action;
- warrant that;
  - the information you have provided is true and correct; and
  - you will not sign-up or register using any false or misleading details;
- hereby execute and agree to be bound by and comply with the terms of the;
  - Retainer Agreement
  and consent to us entering the information you have provided to us into those documents
- have been given the opportunity to obtain independent legal advice as to the nature and effect of the Retainer Agreement, and you agree to be bound and comply with the terms of our Retainer Agreement.;
  - after obtaining, and in reliance on such independent legal advice; or
  - having elected not to obtain independent legal advice; and
    - you have read and understood the nature and effect of our Retainer; and
    - you do not require any explanation or advice in relation to those documents;
- consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and
- consent to receive further communications from us regarding any continued participation in the action.
Signature*
Consent*
By submitting this form you:

Reasonably believe that you will be eligible to participate in the action;

Warrant that: the information you have provided is true and correct; and you will not sign-up or register using any false or misleading details;

Consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and Consent to receive further communications from us regarding any continued participation in the action
I agree to the terms and conditions.
*
- I understand that the retainer and the disclosure letter are confidential documents. I understand that I am not permitted to share these documents or the information contained therein with any third party or for any purpose other than participating in the proposed proceedings.
If you would prefer to sign a hard copy of this agreement, please print out a copy of the Retainer Agreement, complete the Claimant Details in the document, sign it, and then scan it as a PDF and email it to: woolworths@aderolaw.com.au.

Register Interest Woolworths

Am I Eligible?

Step 1 of 3

Disclosure Letter

By signing below and submitting this form you:

Canberra

Melbourne

Sydney

Adelaide

Register Interest Woolworths

Am I Eligible?

Step 1 of 3

Disclosure Letter By signing below and submitting this form you:

Disclosure Letter

By signing below and submitting this form you: