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Policy Holder Information
Policy Number:
Company Name:
Primary Contact Person:
Main Phone:
Work Phone:
Email:
Where should we contact you:
Best time to contact you:
Claim/Loss Information
Date of Loss or Accident:	Date and time
Adress:
City/Province:
Please provide as much detail as possible regarding the claim in the spece provided below. A representative will contact you shortly. (Max 500 characters):
Police Contacted:	YesNo
Officer's Name:
Officer's Badge Number:
Report Number:
Did any injuries result from the Loss/Accident:	YesNo
If yes, please provide names, addresses, phone numbers and the extent of the injuries.:
Name of your broker:

Disclaimer

If you have a claims emergency please refer to the claim tab on our website for a list of insurance companies who have 24/7 emergency toll free numbers to assist you.

If you do not have access to a computer or know the insurer your coverage is with, you can contact our After Hours Emergency Number at
705-529-4139.

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CHRISTMAS & NEW YEARS HOLIDAY SCHEDULE:

        Mon Dec 24th   OPEN 8:30 - Noon
        Tues Dec 25th CLOSED
        Wed Dec 26th   CLOSED
        Thurs Dec 27th Reg Hours 8:30 - 5:00
        Fri Dec 28th       Reg Hours 8:30 - 5:00
        Sat Dec 29th      CLOSED
        Sun Dec 30th     CLOSED
        Mon Dec 31st     OPEN 8:30 - 2:00pm
        Tues Jan 1st       CLOSED
        Wed Jan 2nd      Reg Hours 8:30 - 5:00

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