Ontario Professional Fire Fighters Association

Ontario Fallen Fire Fighters Memorial Submission

First Name of Deceased *

Last Name of Deceased *

Municipality *

Rank *

Age *

Date of Death *

Cause of Death *

WSIB Number *

WSIB Confirmation Letter *

Claim Accepted *

Wall Display

Please indicate how you would like the name to be displayed on the wall. Include the name, Year of Death, Municipality, and Rank. For example: JON DOE | 2025 TORONTO CAPTAIN.

KIN INFORMATION

Next of Kin First Name *

Next of Kin Last Name *

Next of Kin Address *

Address 2

City *

Province *

Postal Code *

E-mail Address *

Please provide the email address of a family member or friend to receive information regarding the memorial.

Next of Kin Phone Number *

Children of Deceased (if known) *

YOUR INFORMATION

Your Organization's Name

Your Fire Chief's First Name

Your Fire Chief's Last Name

Your First Name *

Your Last Name *

Your Title *

Your Address *

Address 2

City *

Province *

Postal Code *

Your Phone Number *

Your Email Address *

Comments

* Required Fields

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