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Required fields are marked with asterisks (*)

Claims Form

(all required fields indicated by an asterisk)

NOTE: THERE IS A 10 DAY NOTICE PERIOD FOR PROVIDING THE TOWNSHIP WITH NOTICE OF CERTAIN TYPES OF CLAIMS AND A TWO-YEAR LIMITATION PERIOD FOR BRINGING AN ACTION IN RESPECT TO ALL CLAIMS.

 

Claimant's personal information

Phone number type
 

Supporting Documentation

Please provide original receipts, repair estimates, photographs or other evidence to substantiate your claim

Did the incident occur as a result of work being performed by a contractor?
 
Did an emergency personnel attend such as paramedics, police or fire?
 
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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Has this incident been reported to anyone at the Township?
 

Witness Information

Witness Phone Number Type
 

Agreement

The information provided herein is factual and a true account of my claim.  I understand that all fraudulent claims cost all taxpayers, and for this reason, all fraudulent claims will be prosecuted to the full extent of the law.

I agree to Terms
 
Clear

Personal information on this form is collected under the authority of Section 10(1) of the Municipal Act, 2001, S.O. 2001, c.25, as amended and will be used to contact you concerning your service request/inquiry to the Township of Centre Wellington. Questions about this collection should be directed to:

 

Township of Centre Wellington

1  MacDonald Square

Elora, ON

N0B 1S0

Emails: claims@centrewellington.ca



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