Report a Claim

Insured Information
Insured Name (required)
Email
Street address (required)
City (required)
Province (required)
Home Phone
Cell Phone
Work Phone

Insurance Company
Name (required)
Branch
Policy Number (required)
Claim Number (required)
Examiner (required)
Examiner Cell
Examiner Email: (required)
Coverage
Insured Property
Agent/Broker

Loss Details
Date of Loss (required)
Type of Loss (required)
Location of Loss
Other Insurance
Driver Last Name
Driver First Name
Handling Instructions
Adjuster of choice
Loss Details

Attatchments (.PDF, DOCX, and DOC files only. 7MB limit)