Actuel Page 1 Aperçu Personal information on this form is collected under the authority of section 23 of the Public Health Act, R.S.P.E.I., Cap. P-30.1, and the Rental Accommodation Regulations under that Act. If you have any questions about the collection or use of this personal information, you may contact Environmental Health, at 902-368-4970 or toll-free at 1-800-958-6400. Identification Enter the tenant's information in the fields below. Prénom Initiale Nom Adresse 1 Adresse 2 Ville, municipalité, communauté Province Code postal Exemple : C1B 0X1 ou 12345 Pays Numéro de téléphone Exemple : 902-555-5555 Adresse courriel Landlord's Information Enter the landlord's information in the fields below. Business/Organization Name Contact Name Address 1 Address 2 City, Town, or Community Province Postal Code For example: C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Complaint Information Have you notified the landlord of this complaint and provided an opportunity for action? - Sélectionner -YesNo Nature of Complaint What is the problem you are experiencing? For example: no heat, no water, leaking roof, rodent/insect infestation CAPTCHA Problème de mathématiques 3 + 2 = Résolvez le problème de mathématiques et tapez la réponse. Ex. : Pour « 1 + 3 », tapez « 4 ».