Instructions for Completing a Municipal Freedom of Information and
Protection of Privacy Act (MFIPPA) Access/Correction Request
Check the bullet that indicates the records you are requesting. Requests for records other than your personal information are
considered General Records.
If you are requesting access to or correction of your own personal information, you will be required to verify your identity using a
valid piece of photo ID.
If you are requesting another person's personal information records, you must provide either:
1.) documentation indicating that you have authority to act for them, or
2.) documentation indicating their consent to release their personal information records to you.
Provide as much detail as possible about the requested records.
Specify the time period for the records as precisely as possible, for example, from 2018-01-01 to 2018-01-05.
If known, indicate the department(s) that the records are located, for example, City Clerk's Office, Human Resources, etc.
If you are requesting records of email correspondence, please indicate:
1.) The City of London email address to be searched;
2.) Key words to be used to search the Microsoft Exchange System and;
3.) The date range of the requested search
Check the bullet that indicates whether you would like to examine original records (on site), if you would like to receive hard
copies, or if you would like to receive electronic copies (records will be provided electronically where possible and appropriate if
this selection is made).
If you are requesting a correction of personal information, please indicate the desired correction and, if appropriate, attach any
supporting documentation to your request form.
A $5.00 non-refundable application fee is required at the time you submit your request. Cash, credit/debit are accepted in person
at City Hall, Clerk's Office, Room 308, 300 Dufferin Ave, London Ontario, N6A 4L9. Cheques may be made out to the City of
London Treasurer and mailed along with the request to the above noted address to the attention of the Manager, Records and
Information Services.
Frequently Asked Questions
How Long Will My Request Take to Complete?
We will respond to a request within 30 calendar days of receipt of the request and the $5.00 application fee, as per
legislative requirements. For requests that involve a large number of records, an extensive search, or consultation with an
external third party, the time may be extended. Requesters will be advised of a time extension.
Is There Any Way to Expedite My Request?
No, but we will make a note on your file that the records are needed urgently; however, there is no guarantee a response will
be made before the 30 day time frame.
Do You Accept Personal Cheques and Who Is It Made Payable To?
Yes. All cheques and money orders should be made payable to the "City of London Treasurer."
How Much Does a Request Cost?
A non-refundable $5.00 application fee must be paid when submitting an Access Request. Additional fees may be charged
under section 45 of the Municipal Freedom of Information and Privacy Protection Act for search time and record preparation,
for example.
For any other questions please call 519-661-2489 ext. 5590
Municipal Freedom of Information & Protection of
Privacy Act Access/Correction Request
Form no. 0958 (2018.08)
Please see instructions before filling our form
Access to Own Personal Information
Correction to Own Personal Information
If request is for access to, or correction of personal information records
Name appearing on the records is the same as person requesting records (below); OR
Other (specify):
Time period of the records
Preferred method of access to records
Receive copy
Examine original(onsite only)
Electronic copies(if applicable)
Detailed description of requested records, personal information records or personal information to be corrected
Personal information on this form is collected pursuant to Municipal Freedom of Information & Protection of Privacy legislation and will be used
for the purpose of responding to your request. Questions should be directed to the Manager of Records & Information Services, City Hall, 300
Dufferin Avenue, PO Box 5035, London ON N6A 4L9 or at 519 661-2489, extension 5590.
Name of person requesting record(s)
Day telephone
Evening telephone
Postal code
E-mail address
$5.00 Application fee
Cheque (made payable to the City of London Treasurer)
Cash (in person only)
Debit/Credit (in person only)
Submit completed and signed request to:
City Clerk's Office, Room 308
City of London
300 Dufferin Avenue, PO Box 5035
London ON N6A 4L9.
Today's date
Signature of person requesting record(s)
For City of London use only
Date received
Request number
Reset form.