Privacy Web Form

Pour remplir cette demande d'accès en français, veuillez cliquer sur le bouton en haut à droite de votre écran.

Please complete this form to submit a request to access your personal information.

Tip:

Hover over the questions to view helpful hints.

First Name

Enter the first name of the data subject

Last Name

Enter the last name of the data subject

Enter email for correspondence with the data request.

Policy Number

Claim Number

Phone Number

Address

City

Province or Territory

Important

If you are requesting access to information on behalf of a customer, we will only respond to your request upon satisfactory confirmation of your identities and relationship.

PIPEDA applies to every organization in respect of personal information that:

The organization collects, uses or discloses in the course of commercial activities; or
Is about an employee of, or an applicant for employment with, the organization and that the organization collects, uses or discloses in connection with the operation of a federal work, undertaking or business.

I am a (an)

Required

Select request type

Required

Please submit a new form per request.

Applicable Laws

The following provinces have private-sector privacy laws that may apply instead of PIPEDA. You should verify the law under which you are submitting your request.

Additional Information

Enter any additional information in this section that will help us process your request. Please refrain from entering any personal information.

To confirm your submission, please print your full name below

If you have any documentation in support of your request, please attach it using the button below. Up to 10 files may be selected. Please note that you will only be able to attach supporting documents once you have filled in the CAPTCHA code above.