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Policy Holder Information

Name of Policy Holder(*)

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Policy Number

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Primary Contact Person(*)

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Phone Number(*)

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Email Address(*)

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Claim/Loss Information

Date of Loss or Accident(*)

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Address(*)

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City/Province(*)

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Please provide as much detail as possible regarding the claim in the spece provided below. A representative will contact you shortly. (Max 500 characters)(*)

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Police Contacted

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Officer's Name

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Officer's Badge Number

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Report Number

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Did any injuries result from the Loss/Accident

Yes

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If yes, please provide names, addresses, phone numbers and the extent of the injuries

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reCAPTCHA(*)

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Important: Emergency after hours claims need to be called in. Online reporting is for non-emergent claims only and will be responded to during regular business hours of 8:30am – 4:30pm Monday to Friday. For after hours emergencies please call 1-800-561-4115.