Damage Claim Form

  • Our employees are instructed to provide this form to you and are not authorized to accept responsibility for claims made.

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    • This request for information does not constitute an acceptance of your claim but permits the Corporation of the City of Quinte West or its Insurance Representative to properly record and investigate your claim.

    • MM slash DD slash YYYY
    • Personal informaton on this form is collected under the authority of the Municipal Act and Insurance Act of Ontario and is used to process claims made against the municipality. For further information please contact insurance@quintewest.ca

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