Free Notice of Accident Form - Ontario

To: Mr./Ms. XXXX, City Clerk, City of XXXXX, Ontario

Copy to: Mr./Ms. XXXX, City Solicitor, City of XXXXX, Ontario

Date: Day, Month, Year

Re: Notice of an Injury on City Property

Dear Mr./Ms. XXXX,

This notice is to inform the City that I have had an accident on City

Property. Here are the details:

Date of Accident:

Time of Accident

Location of Accident

My date of Birth:

My Name:

My Address:

I reserve all my rights in this matter.

Respectfully,

c.c. City Solicitor