Consumers - Magermans & Raes Insurance Brokers Ltd.

Consumers

Online Claim Reports – Property Claim


Policy Holder Information
Policy Number:
Name of Policy Holder:
Home Phone:
Work Phone:
Primary Contact Person:
Where should we contact you?
Best time to contact you?

Claim / Loss Information
Date of Loss or Accident:
Address:
City / Province:
Please provide as much detail as possible regarding the claim in the spece provided below. A reporesentative will contact you shortly. (Max 255 Words)
Police Contacted?	Yes No
Officer's Name:
Officer's Badge Number:
Report Number:
Name of your broker:

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