Send New Assignment

To submit an assignment, please complete the following form.

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

1. Submitter Information

Name

Email

Company Name

Address

City

Province

Postal Code

Phone Number

2. Claim Information

Insurer

Insured Name

Claim Number

Policy Number

File Number

Insured Phone Number

Insured Email

3. Contractor Information

Project Manager Name

Project Manager Phone Number

Project Manager Email

4. Loss Information

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

Special Instructions

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