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Make a Claim

All losses reported to the company outside of business hours will be responded to the next business day. Our office hours are 8:30am to 4:30 pm - Monday to Friday. If your loss is an emergency and can not wait until the next business day you may contact our Emergency on-call Claims Representative by simply calling our office, and follow the voice mail prompts. Click here for our contact numbers.

Personal Information

Your details

* Name of Policyholder/Insured
* Street No. and Name	Apt No.
* City	* Province
* Country	* Postal Code
* Home Phone	* Cell Phone
Work Phone
* Best Number to be reached at	* Email Address

Insurance Information

Contact details

Policy Number	Agent/Broker
* Type of Loss	* Location of the Loss
* Details Regarding the Loss	Other Remarks

Auto Claim Information

Auto details

* Is the driver the Policy Holder? Yes No	* Drivers Relation to Insured
* Drivers' Name	* Street No and Name
Apt No.	* City
* Country	Province/State
Postal Code/Zip Code	Driver's License Number
* Vehicle Make	* Vehicle Model
* Vehicle Year	VIN Number
* Is the vehicle drivable? Yes No	* Location of the Vehicle now
* How many passengers (excluding driver)	* Were there any injuries? Yes No
If yes, Names of injured	Nature of injuries
Age of injured	Phone Number
* Were other vehicles involved in the accident? Yes No	Name of driver
Insurance Company
Vehicle Make	Vehicle Model
Vehicle Model Year	Drivers License Number
Were there any injuries? Yes No
Location of the vehicle now	Other Remarks