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Auto Claim Report

CALL POLICE AND FILL OUT THE FOLLOWING

* Denotes a mandatory fields (n/a if not available)

1. Policy Details
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2. Insured Details
3. Police Information Details
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4. Driver Information
 
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5. Witness Detail

IF THE WITNESS IS A MOTORIST AND YOU ARE UNABLE TO OBTAIN THEIR NAME AND ADDRESS, RECORD THEIR VEHICLE LICENSE PLATE NO.

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All losses should be reported directly to: Joel Carey of Partners Indemnity Brokers.

Business No.: (905) 336-1302
Mobile No.: (905) 876-6411
Facsimile: (905) 681-1054
E-mail: jcarey@csrm.ca