Last Name
(Required)
First Name
(Required)
Address
(Required)
Street Address
City
Postal Code
Daytime Phone Number
Other Number
Email Address
May a message be left at your daytime telephone number?
Yes
No
Are you representing someone else in this complaint?
Yes
No
Last Name
First Name
Address
Street Address
City
Postal Code
Daytime Phone Number
Other Number
Email Address
What is your complaint?
(Required)
Who is your complaint about and when did it happen? (Specify the provincial department, agency or municipality the complaint is about.)
(Required)
Whom have you dealt with about this problem? (List names, phone numbers, addresses and when you last had contact with them.) Explain the steps you have taken to solve this problem.
(Required)
Have you received anything in writing from the department, agency or municipality? (Please tell us what you have received. We may ask you to fax or mail these documents to our office after we review your complaint.)
(Required)
Did you file an appeal or ask for a review? If yes, when was the last appeal or review and what was the result?
Why do you believe you have been treated unfairly?
How can this problem be solved?
Is this matter urgent? Please explain why.