This form is to be completed by a person claiming that Ontario Northland is responsible for damage to their property or for bodily injury suffered by them or an affiliated person.

Instructions: Provide as much information as possible, including any supporting documentation, to allow Ontario Northland to evaluate your claim.

Claimant Information

Collection and Use of Personal Information:  The personal information contained in this form is being collected pursuant to the Ontario Northland Transportation Commission Act and will be used by Ontario Northland to process your property damage or bodily injury claim.  Questions about this collection should be directed to: Privacy Officer, 555 Oak Street East, North Bay, ON, P1B 8L3, (705) 472-4500,

Incident Details

Describe what happened as well as the extent of the damages or injuries that you sustained and state why you believe Ontario Northland should be responsible for those damages or injuries. 
Indicate the amount of money that you are claiming from Ontario Northland. 
Upload any photos, invoices, receipts, or other evidence that you have to support your claim.

Witness Information


Declaration & Disclaimer