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Find an Application
Home
Products
Commercial Property/Casualty
Environment Liability
Professional Liability
Residential Insurance
Specialty Programs
Day Liability
Independent Carriers
Storage Program
Woodchuck
Applications
Claims
About Us
News
Careers
Contact Us
Asset 1
Find an Application
Claim Form
Claims Notice
Please complete the following form to notify our claims department of a new claim OR contact our claims department at 1-844-531-1841. After hours, please use option#3.
Type of Risk
*
Please select an option
Habitational
Recreational Vehicle/Motorhome
Motorcycle
Manufactured Home
Commercial
Insured Name
Please enter the first and last name of the policy holder
First Name
*
Middle Name
Last Name
*
Contact Phone Number
*
Please enter the phone number of person to be contacted in regards to this loss.
Contact Email
*
Please enter the email which we may contact regarding this loss.
Contact Name
*
Please enter the name of the person to be contacted.
Brokerage Name
*
Please enter the name of the Brokerage this policy was placed with
Policy Number
*
Type of Loss
Water
Theft
Fire
Hail
Wind
Snow/Ice
Liability
Impact
Animal
Crime
Collapse
Falling Object
Power Surge
Mechanical Breakdown
Vandalism
Other
What caused the claim?
Description of Loss
*
Please enter a description of the loss, include police file number if applicable.
Location of Loss
Please enter the location of where the loss occurred
Street Address
*
City
*
Province
*
Postal Code
*
Date of Loss
*
Month
*
Day
*
Year
*
When did the loss occur?
SUBMIT