Actuel Page 1 Page 2 Aperçu Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15-01 as it relates directly to and is necessary for the Coastal Hazard Assessment and will be used to administer this program. If you have any questions about this collection of personal information, you may contact the Climate Change division at 902-620-3232. Information may be verified. Identification Please provide your contact information. Nom de l’entreprise/organisation Prénom de la personne-ressource Nom de la personne-ressource Adresse 1 Adresse 2 Ville, municipalité, communauté Province Code postal Exemple : C1B 0X1 ou 12345 Pays Téléphone 1 Exemple : 902-555-5555 Téléphone 2 Exemple : 902-555-5555 Télécopieur Exemple : 902-555-5555 Adresse courriel Would you like the completed Coastal Hazard Assessment sent to you by email or mail? If you choose email, you must provide an email address in the field above. - Sélectionner -EmailMail What is the reason for your request? - Sélectionner -I am the registered owner of the property.I am (or I represent) a prospective buyer of the property.I represent the municipality that the property is located in.I am conducting research.I am applying for a development permit.I am applying to subdivide the property.I am applying for funding and the CHA information is required.Other Other Reason If you would like a copy of your completed CHA sent to a third party (ie municipality, Provincial Planning department, funding agency), provide the additional email address: Is your mailing address the same as what you entered in the fields above? - Sélectionner -YesNo Mailing Address Address City, Town, or Community Postal Code For example C1B 0X1 or 12345