Liability Claim Report

DO NOT ADMIT FAULT, LEAVE THE SCENE OR DISCUSS WITH ANYONE EXCEPT POLICE. CALL POLICE AND COMPLETE THE FOLLOWING INFORMATION:

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

1. Policy Details
RadDatePicker
RadDatePicker
Open the calendar popup.
RadDatePicker
RadDatePicker
Open the calendar popup.
2. Insured Details
3. Police Fire Dept Information
4. Owner Information
RadDatePicker
RadDatePicker
Open the calendar popup.

select
5. Injured
6. Witness Detail
7. Adjuster Details
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