Civil Liability Claim Form Fill out the following form. We will take care of the rest. All fields marked with an asterisk (*) are mandatory. First name * Last name * Company name Address * Address line 2 City * Province * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Others Postal code * Phone number * Alternate phone number Email * Policy number * Incident date More details on the incident * Questions/concerns you want to communicate to our claim team Upload documents relevant to the claim (upload all files at once) Choose files (max. 3 - 5MB each) Submit
