Kawartha Logo The Corporation of the
City of Kawartha Lakes
Risk Management
P.O. Box 9000, 26 Francis St.
Lindsay, ON K9V 5R8
Tel: (705) 324-9411 ext 1380
CLAIM REPORT Fax: (705) 324-7058
E-Mail: riskmanagement@kawarthalakes.ca


The City of Kawartha Lakes claims process is located on our website at www.kawarthalakes.ca

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

PLEASE PROVIDE/ATTACH PHOTOS, INVOICES, AND ANY OTHER RELEVANT DOCUMENTATION IN THE ATTACHMENTS SECTION IN SUPPORT OF YOUR CLAIM ALONG WITH THIS CLAIM FORM

NOTE: This form is no longer active. An updated version of this form can be found here: https://clearrisk.tfaforms.net/416

PERSONAL INFORMATION OF CLAIMANT











CONTACT INFORMATION (if different from above)










INCIDENT INFORMATION


Please indicate 'AM' or 'PM'






EMERGENCY PERSONNEL ATTENDED (Check all that apply)






WITNESS INFORMATION
WITNESS (1)



WITNESS (2)



FILES AND ATTACHMENTS













REPORTING INFORMATION



SUBMISSION CONFIRMATION

The personal information collected to investigate your claim is collected under the authority of the Municipal
Act 2001, S.O. 2001, c. 29 and will be disclosed to staff and service providers who require the information
to investigate your claim against the City of Kawartha Lakes. Questions about the collection of this
personal information should be directed to the City Clerk or Deputy Clerk at (705) 324-9411 extension 1295
or 1322.

Contact Information