Access/Request Municipal Freedom of Information and Protection of Privacy Act

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Applicant Information

Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Telephone Number *

Email Address *

Request for: *

Access to general records
Access to own personal information
Correction to own personal information

Please provide a detailed description of requested records, personal information, or personal information to be corrected. If you are requesting access to, or correction of, your personal information, please identify the personal information bank or record containing the personal information, if known. *

Please Note

If you are requesting a correction of personal information, indicate the desired correction and if appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may require that a statement of disagreement be attached to your personal information.

Please provide supporting documentation if appropriate

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide the preferred method of access to records *

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Freedom of Information Disclaimer

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of processing this application and administering the legislation and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Municipal Freedom of Information and Protection of Privacy Act stipulates that Municipalities shall charge fees for access to a record. Municipalities shall charge for photocopies, records provided on a CD-ROM, for manually searching and preparing a record, along with any other costs incurred by the Municipality in producing access to the record. For a full review of the fees that Municipalities are obligated to charge, please click here:

https://www.ontario.ca/laws/regulation/900823

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.

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Date *

Name

Applicant Information

Please Note

Freedom of Information Disclaimer

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