Customer Care Centre - CMD Insurance Services Inc.

Customer Care Centre

Report A Claim – Business Claim


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:
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:
Did any injuries result from the Loss / Accident:	Yes No
If yes, please provide names, addresses, phone numbers and the extent of the injuries.

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