Claim Report Forms

Notice of Property Claim

In an emergency claim situation, please contact us at (905) 833-6691.
Please take your time filling out this form. You will be given an opportunity to check for errors. Note that items marked with an asterisk are required.


Policy Holder Information
Policy Number:*
Name of Policy Holder:
Home Phone:*
Work Phone:
Primary Contact Person:*
Where should we contact you?
Best time to contact you?

Claim / Loss Information
Date of Loss or Accident:
Address:
City / Province:
Please provide as much detail as possible regarding the claim in the spece provided below. A reporesentative will contact you shortly. (Max 255 Words)
Police Contacted?*	Yes No
Officer's Name:
Officer's Badge Number:
Report Number:
Name of your broker: