Please see instructions section before filling out this form
Name of institution request made to
Description of Records or Correction Requested
Examine original (on site only)
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.
Date received (yyyy/mm/dd)
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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Disponible en français
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.
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).
Please ensure you have entered your name, address and telephone numbers accurately.
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.
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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