Any information which you provide on this on-line form will be kept confidential.
Personal information on this form is collected under the authority of the Municipal Act 2001, S.O. 2001, C.25 and will be used in maintaining evidence of insurance associated with the City of London. Questions about the collection of this personal information should be directed to the Manager, Risk Management, 300 Dufferin Avenue, London, ON N6A 4L9 519-661-CITY (2489) ext. 5435.