Civil Complaint & Investigation Intake — Ontario

1. Complainant (You)

Given name(s): _________________________ Family name: _________________________

Former names: _________________________ DOB: ____ / ____ / ______

Citizenship / residency: _________________________ Occupation: _________________________

Employer: _________________________ How did you hear about EBBI? _________________________

2. Contact

Home address: _________________________________________________________________

City: _________________ Province: __________ Postal: ______ ______

Mailing address (if different): ___________________________________________________

Phone: _________________________ Email: _________________________________________

Preferred contact: ☐ Email ☐ Phone ☐ Text   Language: _________________________

Emergency contact: _________________________ Phone: _________________________

3. Respondent (Party complained against)

☐ Individual   ☐ Organization   Full legal name: __________________________________

Also known as: _________________________ Business / incorporation #: _________________________

Address: _________________________________________________________________________

Phone: _________________________ Email: _________________________________________

Your relationship to respondent: ___________________________________________________

Other parties involved: __________________________________________________________

4. Type of matter

☐ Breach of contract ☐ Debt / money ☐ Property damage ☐ Employment ☐ Landlord–tenant

☐ Estate ☐ Family (not divorce) ☐ Fraud ☐ Defamation ☐ Human rights ☐ Harassment ☐ Other

Existing court case? ☐ No ☐ Yes — File #: _________________ Court: _________________________

5. What happened

Date dispute began: ____ / ____ / ______   Location: __________________________________

Chronological summary (use additional pages if needed):

Why respondent is responsible:

Harm / loss suffered: _____________________________________________________________

Estimated financial loss (CAD): _________________________

Prior resolution attempts: _______________________________________________________

6. Relief sought

☐ Money damages ☐ Injunction ☐ Declaration ☐ Contract performance ☐ Settlement ☐ Investigation

Describe outcome you want:

Amount claimed (if damages): _________________________ Willing to settle? ☐ Yes ☐ Maybe ☐ No

7. Evidence & witnesses

Documents on hand: ☐ Contract ☐ Emails ☐ Texts ☐ Photos ☐ Invoices ☐ Court papers ☐ Police ☐ Medical ☐ Other

Police occurrence #: _________________________ Documents needed: _________________________

Witness 1: _________________________ Contact: _________________ Saw: ____________________

Witness 2: _________________________ Contact: _________________ Saw: ____________________

Witness 3: _________________________ Contact: _________________ Saw: ____________________

8. Legal history & declaration

Prior lawyer on this matter? ☐ No ☐ Yes — Name/firm: ____________________________________

Limitation deadline: ____ / ____ / ______   Next court date: ____ / ____ / ______

Urgency: ☐ Routine ☐ Soon ☐ Urgent ☐ Emergency

I confirm the information is true and authorize conflict check. Signature: _________________________ Date: ____ / ____ / ______