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

Verify your Submission

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