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Representative Request

If you're an applicant or respondent in a CRT 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 their representative. We will follow up with you once we review and process your form.

"*" indicates required fields

Your Contact Information

Mailing Address*

Representative's Contact Information

The representative's full legal name*
Will this person be a witness in your claim?*
Is this person a lawyer?*
What is their relationship to you?

If you want your insurer to represent you, is this person an authorized employee of your insurance company?
If you want your insurer to represent you, are they required to provide coverage for damages if the other party is successful?
If you don't know, ask your insurer.


MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.