Access or Correction Request
Freedom of Information and Protection of Privacy Act
Municipal Freedom of Information and Protection of Privacy Act
Please see instructions on page 2 before filling out this form
A. Type of Request
Access to general records (non-personal information)
Access to own personal information
Access to other’s personal information by authorized party
Correction of own personal information
Name of institution request made to
B. Requester’s Information
Last name First name Middle initial
Unit/Apt. no. Street no. Street name PO box
City/Town Province Postal code
Home phone no. (include area code) Business/Mobile phone no. (include area code & extension)
C. Description of Records or Correction Requested
Time period of the records Method of access
From (yyyy/mm/dd) To (yyyy/mm/dd)
Receive copy Examine original (on site only)
D. Payment and Signature
$5 application fee Signature Date (yyyy/mm/dd)
Cheque Cash (in person only)
Personal information contained on this form is collected under the Freedom of Information and Protection of Privacy Act or Municipal Freedom of
Information and Protection of Privacy Act and will be used to answer your request.
Questions about this collection should be directed to the Freedom of Information and Privacy Coordinator at the institution where you make the request.
Available on-line at ontario.ca. This form will be kept for 6 years from the date of completion. Once completed, this form has a sensitivity level of medium.
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E. Institution Use Only
Date received (yyyy/mm/dd) Request no. Comments
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Instructions for Completing Access or Correction Request
Informal Access to Records
Many records of public institutions are available to you without making a request under the Freedom of
Information and Protection of Privacy Act or the Municipal Freedom of Information and Protection of Privacy
Act. Contact the Freedom of Information and Privacy (FOIP) Coordinator at the institution that holds the records
to determine whether you need to make a formal request.
A. Type of Request
Check the box that indicates what you are requesting. (Records that do not contain personal information are
general records.)
The FOIP Coordinator is required to verify your identity before giving you access to your own personal
information.
If you are requesting another person's personal information records, you must provide proof that you have the
authority to act for them (e.g., power of attorney, guardian or trusteeship order).
B. Requester's Information
Please ensure you have entered your name, address and telephone numbers accurately.
C. Description of Records or Correction Requested
Provide as much detail as possible about the requested general records, own personal information, other's
personal information or correction of own personal information. Use a separate sheet of paper if you need more
space and attach it to this form.
If you are requesting personal information records, provide the name that should appear on them.
Specify the time period for the records as precisely as possible, e.g., from 2008/07/21 to 2009/11/30.
If you are requesting a correction of your own personal information records, describe the correction you want
and provide any supporting documents. If possible, provide copies of the information to be corrected and the
information you wish to have it replaced with.
Check a box to indicate whether you want to examine original documents (which may only be done on site) or
receive copies.
D. Payment and Signature
A $5 application fee is required. Cash payments must be made in person.
Make cheques payable to the appropriate payee of the institution that holds the records. The payee for
Government of Ontario ministries is the Minister of Finance.
Sign and date the form and mail it or submit it in person to the institution that holds the records.
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