Auto and Home Non-Emergency Claims Form

Use this form for home and property, auto and leisure products claims. Please fill in all required fields and provide as much information as possible. For auto claims, information collected about third parties (if applicable) is necessary in order to investigate and settle your claim. By completing this form, you agree to have a claim file set up and to be contacted by an insurance adjuster.

You can also report your claim by calling Curo Claims Services at 1-866-952-2876.

* Required Field

Person Reporting Claim

* First and last name:

Insured Information

* First and last name (as appears on policy):

* Policy Number:

* Address:

* City/Town:

* Province:

* Postal Code:

* Phone Number:

( ) -

Email:

* Date of Incident:

* Time of Incident:

* Incident Location (City and Province):

* Describe what happened:

* Are you submitting an auto claim?:

YesNo

Insured Vehicle Information

* Vehicle Make, Model and Year:

* Vehicle Plate Number:

* Vehicle Location:

* Drivable:

YesNo

* Details of Damage:

* Name of Driver:

* Number of Passengers:

* Were there any injuries?:

YesNo

* Please detail who was injured and the nature of those injuries:

* Number of other Vehicles Involved:

Vehicle 1 Information

Driver:

Address:

City/Town:

Province:

Postal Code:

Phone Number:

( ) -

Number of Passengers:

Insurance Company:

Policy Number:

Vehicle Make, Model and Year:

Vehicle Plate Number:

Vehicle 2 Information

Driver:

Address:

City/Town:

Province:

Postal Code:

Phone Number:

( ) -

Number of Passengers:

Insurance Company:

Policy Number:

Vehicle Make, Model and Year:

Vehicle Plate Number:

Vehicle 3 Information

Driver:

Address:

City/Town:

Province:

Postal Code:

Phone Number:

( ) -

Number of Passengers:

Insurance Company:

Policy Number:

Vehicle Make, Model and Year:

Vehicle Plate Number:

* Were the police involved?:

YesNo

Police Information

Police Force:

Name of Officer:

Officer Badge Number:

Incident Number: