NOTICE OF COLLECTION OF PERSONAL INFORMATION

The personal information collected on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and By-law No. A.-6377-206, and Policy 24(5) Special Assistance and Supplementary Aid and will be used to determine eligibility for and administration of London’s Subsidized Transit Program and Discretionary Benefits program. Questions about this collection should be addressed to the Manager of Discretionary Benefits at 785 Wonderland Rd., London, ON N6K 1M6 Tel: 519- 661-5910