Complaint Form

On whose behalf are you filing a complaint?*
- I’m filing a complaint for myself.
- I’m filing a complaint on behalf of another person.
- I am filing a complaint for a partner organization (company, organization).
- I am filing a complaint for a group or association.
Name of person:*
Card number:*

Contact information
First Name*
Last Name*
Organization Name, if applicable
Phone number*

Enter a phone number to reach you between 8:30 am and 4:30 pm
Email address*

An acknowledgment will be sent to this email address.
This address will be used to process your request.
Additional information
Address*
Street*
Apartment, suite, unit
City*
Province*
Postal code*
Date of birth*

Date Format: YYYY dash MM dash DD

This information is only used for identification purposes.

Contact information