Complaint Information

Complainant Information:
(* required field.)

First Name:*

Middle Name:

Last Name:*

Date of Birth: *

Gender: *

Address: *

City: *

Province: *

Email: *

Phone 1:
* - -

Phone 2:
- -

When did this happen? Please indicate what date this occurred or when you discovered the occurrence.

Between Date: *

Time:
and Date: *

Time:

Where did this happen? Please indicate the location of the occurrence. If this is a business or residence please enter the street address.

Occurrence Address: *

Or: This address is the same as my home address.

What Happened? Please tell us in your own words exactly what happened. Please be as detailed as possible.

Occurrence Description: *

Please list all property involved with this occurrence. List items 1 per line, include descriptions and any uniquely identifying information such as serial numbers.

You must also list approximate value in loss or damages. Please remember that total loss or damages exceeding $5,000 are not eligible for an online report.

Property Information: *

Total Approximate Value of Loss or Damage: *
$

You have the option of uploading one photograph (eg. graffiti or damage) The photograph must be of type JPG, PNG or GIF and cannot exceed 6Mb (6,000kb)