Request for Access to Records

Contact information

Business name (if applicable)

Title

Full name (first and last)

Address

City/Town

Province

Postal Code

Daytime phone

Email address

Details of request

The Freedom of Information and Protection of Privacy Act can only be used to request copies of recorded information, not pose questions to be responded to. Please ensure your request for copies of records is clear and specific. This will help reduce processing time and fees associated with your request, and assist us in responding accurately.

Records Requested (describe records, be as specific as possible):

Reference or file # (please specify, if known):

Date or date range of records (please specify, if applicable):

Are you requesting access to another person’s personal information?

Yes (Please attach the third party’s written consent/agent authorization.)

If so, please attach, as appropriate:

That person’s signed consent for disclosure, or
Proof of authority to act on that person’s behalf

One file only.
32 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

How would you like to receive the responsive records?

Electronically

Regular mail

Pick up physical copy

NOTE: In accordance with the Act, fees may be charged to process this request.

Your signature (typed name)

You will receive a copy of your request to the email address provided above.

Personal information is collected by the Municipality of North Cowichan under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act for the purpose of responding to this request for access to records. Should you have any questions about the collection of this personal information, please contact the Information Management Officer at FOI@northcowichan.ca

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