Making a Claim Against the Region

Personal information on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of reviewing your claim.

* = Required

Claimant Information

Contact Method

Details of the Claim

  

Time :

* City / Town

 (attach copies of invoices, estimates, receipts near bottom of page)

Vehicle Involved

Vehicle Details

Incident Details

Passengers (In vehicle at the time of the incident)

Direction of Vehicle

Condition of Road

 

Supporting Documentation

Submit electronic documents (photos, reports) supporting my claim. Each file has to be a maximum of 5 MB, and all files must be less than 10 MB.

Only PDF, JPG, DOC(X), XLS(X), PNG and TXT formats will be accepted.

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email our Access and Privacy Office or call 905-980-6000 ext. 3779.

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