Required fields are marked with asterisks (*)

Submit a Claim

Before submitting a claim, please make sure you have read and understand the claims process with the Town of Saugeen Shores.

Click here to review information on the Claims Process

Name of claimant

Address

Phone Number

Email Address

Date of incident/accident

Time of incident/accident

Location of Incident/accident

Please select the type of damage or injury from the list

Fallen Trees and Branch Damage

Flood (Sewer Back Up / Watermain Break)

Winter Plow Damage (including lawn damage)

Pothole

Trip, slip or fall

Other

Please provide a brief description of the incident /accident

If you have images or documentation to support your claim, please upload them here

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Did you notify any employee of the Town of Saugeen Shores prior to the completion of this form

Yes

Did you notify your insurance company of this incident or injury prior to this claim

Yes

What compensation or corrective action are you seeking?

Additional questions or comments:

I hereby certify that all the information provided by me in this application (or any other accompanying documents or pictures) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts may cause denial of the claim or delay in the processing of the claim.

Notice Of Collection:

The information you provide will be used to review, investigate and determine eligibility for the claims against the Town. Questions about this collection can be directed to the Chief Financial Officer at 519-832-2008 x 110.

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Submit a Claim

Before submitting a claim, please make sure you have read and understand the claims process with the Town of Saugeen Shores.

Click here to review information on the Claims Process

Notice Of Collection: