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Submit a file

File Details

What is the nature of your claim?

Date of Loss

Location of Loss

Insured or Client Name

Your File Number

Which insurance company are you acting on behalf of?

Insurance Company

Policy Number

Claim Number

# of Vehicles Involved

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Insured’s Details

Name

Contact Number

Vehicle Information

Year / Make / Model

Current Location of Vehicle

Passenger Details

Drivers Name (if not the insured)

Number of Passengers

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Notes & Instructions

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Third Party Details

Name

Contact Number

Vehicle Information

Year / Make / Model

Current Location of Vehicle

Passenger Details

Drivers Name (if not the insured)

Number of Passengers

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Your Details

Email Address*

Full Name*

Company Name*

Position

Address Line 1*

Address Line 2

City*

Province*

Postal Code*

Phone*

Ext.

Fax

Select an Office

Are you an independent adjuster?*

yes
no

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