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Edmonton East
Edmonton West
WEM (CanTrust)
Stony Plain
Get a Quote
Insurance
Auto Insurance
Bundled Home and Auto
Car
Motorcycle
Property Insurance
Homeowner
Condo owner
Tenant
Rented Dwelling
Commercial Insurance
Business
Recreational Insurance
Recreational Vehicles
Boat Insurance
Life Insurance
Life
Claims
About
About Us
History
Careers
Blog
Contact
Edmonton East
Edmonton West
WEM (CanTrust)
Stony Plain
Get a Quote
PCR-Client: Claim: Home
This form will allow you to report a claim to our brokerage. You may save and continue later if necessary.
Your Information
Are you currently insured with our brokerage?
Yes - I am a client of the brokerage
No - I am a third party filing a claim against a client of the brokerage
Name
First
Last
Primary phone number
*
Secondary phone number
Email
Address
*
Street Address
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
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Quebec
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Yukon
Province
Postal Code
Your policy info
Policy number
*
Insurance carrier
*
Please Choose
Aviva Insurance Co.
Economical Insurance Co.
Intact Insurance Co.
Nordic Insurance Co.
Optimum West Insurance Co.
Peace Hills Insurance Co.
Royal and Sun Alliance Facility
Wawanesa Mutual Insurance Co.
Other - not listed
Please type in the name of your insurance carrier
*
Loss Information
When did the loss occur?
*
YYYY dash MM dash DD
What time did the loss occur?
:
Hours
Minutes
AM
PM
AM/PM
Please describe the incident, including WHERE it occurred and WHAT exactly happened
If you have filed a Police Report, please provide the police report number as well as the police force that the report was obtained from
Upload photos or documents
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Select files
Accepted file types: pdf, jpg, gif, png, Max. file size: 2 MB, Max. files: 10.
Please upload any files you feel are relevant (pictures, police report, etc.). Maximum 10 files, up to 2MB each.
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