Access Request
Freedom of Information and Protection of Privacy Act


Personal information on this form is collected under section 26 of the Freedom of Information and Protection of Privacy Act and will be used for the purpose of processing and responding to your request for records. If you have any questions, please contact Privacy & FOI at
604-661-6828.

Request Type

* required  
* Access to general records (non-personal information)
Access to own personal information
Access to other's personal information by authorized party
(must send appropriate consent/authorization)

Requester's Information

 
First Name *
Last Name *
Address *
City *
Province *
Postal Code  *
Phone Number  *
Date of Birth  *
dd-mmm-yyyy
Email Address *
Confirm Email Address *

Description of Records Requested

  • Please be as specific as possible to assist the search process.
  • If you are requesting personal information, it is often necessary to match a unique identifier from the requested file(s). Please provide one unique identifier from the following, if applicable.

Claim Number
Driver Licence Number
Employee Number
Other File Number/Identifier
Time Period of the Record(s) From

dd-mmm-yyyy
To

dd-mmm-yyyy

Description of Record(s):

Do you want to: * Receive an electronic copy of the records
(Sent by Canada EPost)
Receive a paper copy of the records
(Sent by Canada Express Post. Signature will be required.)