Required fields are marked with asterisks (*)

Claim Report

Information on the Municipality of Dysart et al’s claims process can be found on our website at https://www.dysartetal.ca/en/municipal-government/claims.aspx.

 Please note: There is a ten (10) day notice period for certain types of claims. There is also a two (2) year limitation period for bringing legal action with respect to most claims.

Please use the attachment section of this report to upload photos or other relevant documentation related to your claim. 

 

Personal Information of Claimant:

Incident Information:

Witness Information:

Witness #1

Witness #2

Files and Attachments:

Please include any photos, invoices/quotations and any other relevant documentation in support of your claim.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Reporting Information:

Submission Confirmation:

The personal information collected to investigate your claim is collected under the authority of the Municipal Act, 2001 and the Insurance Act of Ontario and will be disclosed to staff and service providers who require the information to investigate your claim.



Contact Us

Subscribe iconSubscribe to this Page