February, 2023 - Haldimand Norfolk Housing

Name

(required)

Address

Please include your street address and unit number so that we can direct your complaint to the correct PM Team. Thank you.

Telephone Number

Email

Date(s) & Time(s) of Incident(s)

Please include all dates and times if there were multiple incidents. If this is a chronic issue, we suggest that you note dates/times of all reoccurances. This information is required should this complain lead to an eviction through the Landlord Tenant Board.

Check One:

A – Incident involves personal damage to me;
B – Incident involves the disturbance of my reasonable enjoyment of the premises;
C – Other: (explain)

Explain

I hereby submit a complaint about the following individual:

If your complaint is not about a specific person, you can skip these fields

Address

Witness (if any) – Name and Address

Attending Police Officer’s Name

(if applicable)

OPP Incident Report #

(if applicable)

Provide a full description including individuals involved & actions taken by you to resolve (attach a 2nd page if needed)

Provide a full description of the complaint or incident.

I understand that I may be required to testify at a Landlord Tenant Board Hearing in order for this matter to be resolved. I understand that due to confidentiality reasons, and in accordance with the Municipal Freedom of Information and Protection of Privacy Act, the HNHC may not be at liberty to discuss the actions taken as a result of my complaint. I understand that various staff will be consulted in order to resolve my concerns. Personal information on this form is being collected pursuant to the Social Housing Reform Act, 2000, S.O. 2000, c.27, Housing Services Act, 2011, and Residential Tenancies Act, 2006 and will only be used to resolve my complaint.

Have you received a copy of the HNHC Tenant Complaint Process?

Yes
No

If you have replied 'No', a copy will be mailed to you. Please ensure you have entered your correct mailing address above.

Signature (type your name)

I certify that all information in my statement is true and correct to the best of my knowledge.

Attn: One-Time Top-Up to the Canada Housing Benefit $500 – Apply before March 31, 2023

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