Representative Request – Intimate Image Claims

Representative Request - Intimate Image Claims

If you're an applicant or respondent in a CRT intimate images claim, use this form to ask the CRT’s permission to have someone speak on your behalf during the CRT process. This form must be submitted by the person being represented, not the representative. We will follow up with you once we review and process your form.

"*" indicates required fields

CRT Dispute Number (eg IS-01-2024-00001)*

Your Contact Information

Your name*

First and Middle Last

If you're participating in this claim as a business: the legal name of the business

Representative's Contact Information

The representative's title, if you know it

The representative's full legal name*

First and Middle Last

The representative's email address*

The representative's phone number (primary)*

The representative's phone number (secondary)

The representative's mailing address*

Street Address Address Line 2 City Province Postal Code

What is your relationship to this representative?*

For example, they are an adult friend or relative, or your parent or legal guardian.

Is this person a lawyer?*

Yes

I don't know

Declaration

By submitting this form, I confirm that this representative is 19 years or older.

Date submitted*

Submitted by (enter your full name)*

Name

This field is for validation purposes and should be left unchanged.