Claim Report Form

Personal information on this form is collected under the authority of the Municipal Goverment Act Part XX, and will be used to process your claim with the Cape Breton Regional Municipality. Questions related to the collection of personal information should be directed to the Municipal Clerk's Office, 320 Esplanade, Suite 405, Sydney, NS B1P 7B9. Tel. 902-563-5010

Important: Please provide/attach photos, invoices, and any other relevant documentation in support of this claim form. Fields marked with (*) are required.
Some types of claims have required advance notice and there are time limitations bringing action against a municipality in respect to all claims.

Personal Information

First Name (and Middle Initial if applicable)(*)

Invalid Input

Last Name(*)

Invalid Input

Unit or Apartment

Invalid Input

Street Number(*)

Invalid Input

Street Name(*)

Invalid Input

City

Invalid Input

Province(*)

Invalid Input

Postal Code(*)

Invalid Input

Home Phone(*)

Invalid Input

Cell Phone

Invalid Input

Email Address

Invalid Input

Incident Information

Incident Date and Time(*)

Invalid Input

Incident Location or Description (including address if known)(*)

Invalid Input

Closest Intersection or Reference Point

Invalid Input

Other

Invalid Input

Description of Incident(*)

Invalid Input

Description of Property Damage or Injuries(*)

Invalid Input

Supporting Documentation Upload

Invalid Input

Upload pictures, invoices, quotes or other supporting documents.

Reporting Information

Officer's Name

Invalid Input

Occurrence Number

Invalid Input

First Report to City(*)

YesNo Invalid Input

If no, identify when report was made to whom

Invalid Input

Witness Information

First Name

Invalid Input

Last Name

Invalid Input

Address if Known

Invalid Input

Home Phone

Invalid Input

Alternate Phone

Invalid Input

Email Address

Invalid Input

Incident Information

What would you like the City to do?

Invalid Input

Any Additional Information

Invalid Input

Calling Customer Service to report an issues is not the same as filing a claim. All claims need to be submitted in writing to the Legal Department and using this form.

Complaints reported to the City through 311 allows you to report a specific issue. For example, the location of a pothole. 311 will create a case for the issue and provide you with a reference number. This number allows you to follow up on the case, for example, to see if the pothole has been repaired. This is not filing a claim and is only reporting the issue.

NOTICE OF UNDERSTANDING

I understand that the use of profanity, abuse, threat, cyber bulling, or any other inappropriate behaviour is not tolerated within the CBRM and complaints of this nature will not be considered.

I confirm that the information in this form is true.

Invalid Input