The information provided herein is true. I understand that submitting false statements and/or
documentation is a form of fraud and is illegal. I acknowledge that fraudulent claims cost taxpayers, and that claims that are determined to be made fraudulently will be prosecuted to the full extent of the law.
I hereby give consent to the City of Welland to collect, use or disclose my information that is necessary and reasonable for the purposes of processing my claim.
I accept that the City will disclose my personal information to the City’s insurance adjuster and/or to those involved in the resulting claim resolution, including but not limited to lawyers, or third parties that are found responsible for losses claimed.