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Auto Claim Details

Policyholder’s Name

Policy Number

Who is reporting the claim?

Reporting Person's Phone Number

Reporting Person's Email Address

Who is the primary contact for this claim?

Someone Else

Same as Reporting Person

Please list any other individuals involved in the incident:

Auto Claim Details

Year of Vehicle

Make of Vehicle

Model of Vehicle

VIN Number (optional)

Auto Claim Details

What type of claim best represents the incident?

Collision

E.g. Damage from hitting another vehicle, object, or rolling over.

Comprehensive

E.g. Damage from theft, fire, hail, vandalism, hitting an animal, etc.

Glass

E.g. Cracks, chips, or full replacements of glass parts only.

I'm not sure

We'll help categorize it based on your description.

On what date did this incident occur?

In your own words, tell us what happened

Describe incident details such as how it happened, what happened, the damage, what occurred after the incident and any other relevant info. If anyone was involved, that info will be requested in the next stage of this form.

Was this incident reported to the police?

Were the police or RCMP notified or did they attend this incident?

Yes

Was this vehicle registered and plated at the time of the incident?

Yes

Auto Claim Details

Add a document, image or video for the icing on your claim cake!

Claim Summary

Policy #
Type: Auto
Policyholder's Name
Who is reporting the claim?
Reporting Person's Phone Number
Reporting Person's Email Address
Primary Contact: Same as Reporting Person
Individuals involved: None
Vehicle
Incident Type
Date of Incident: 04/09/2026
Description
Reported to Police?: No
Vehicle Registered?: No
Attachments

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