Send New Assignment

To submit an assignment, please complete the following form.

  • Loss Information
  • Submitter Information
  • Claim Information
  • Contractor Information

1. Loss Information

Insured Name

Insured Phone Number

Insured Email

Loss Address

City

Province

Postal Code

Date of Loss

Service Required

Service Required 2

Service Required 3

Service Required 4

Service Required 5

Description of Loss - Please do not comment on causation or responsibility

Attach Files

2. Submitter Information

Name

Email

Phone Number

Company Name

Address

City

Province

Postal Code

3. Claim Information

Insurer

Claim Number

Policy Number

4. Contractor Information

Project Manager Name

Project Manager Phone Number

Project Manager Email