This notice of Claim is for information only and does not infer acceptance of liability by the City of Brantford.
Notice of Collection of Personal Information: The personal information collected on this form is collected under the authority of sections 279(1) and 10(1) of the Municipal Act, 2001 as amended, and will be used to contact claimants to process a claim filed against the municipality.
Questions about this collection should be directed to the Claims & Insurance Analyst, 58 Dalhousie Street, Brantford, Ontario N3T 2J2, (519) 759-4150
To substantiate your claim, provide original purchase receipts, repair estimates, photos, or other evidence.
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The information provided herein is factual and a true account of my claim.
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 City of Brantford. Questions about this collection should be directed to:
City of Brantford Customer Contact Centre Brantford City Hall 58 Dalhousie Street, Brantford, Ontario N3T 2J2Telephone: 519-759-4150 Email: claims@brantford.ca
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