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Submit a Claim
Report a property or liability claim to Mutual Fire Insurance.
1
Reporting Information
2
Claim Information
3
Broker Information
URL
This field is for validation purposes and should be left unchanged.
All fields marked Required must be completed.
Who is completing the form?
(Required)
Policyholder
Insurance broker
Other
Insured
(Required)
Person
Company
Insured Name
(Required)
First
Last
Insured Company
(Required)
What is the insured address?
(Required)
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
What is the insured's email address?
(Required)
What is the insured's phone number?
(Required)
Mobile number preferred.
How does the insured prefer to be contacted?
(Required)
Text
Email
Phone
What is the policy number?
What kind of claim are you reporting?
(Required)
Property
Liability
When did the loss happen?
(Required)
Year
Month
Day
Can you please provide details about the loss?
(Required)
Write a detailed description of what happened.
Is the location of the loss the same as the insured address?
(Required)
Yes
No
Location of loss address
(Required)
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Date loss reported to the broker
(Required)
Year
Month
Day
Has someone attended the loss?
(Required)
Adjuster
Restoration Company
Unattended
Adjuster company name
Adjuster phone
Restoration company name
Restoration company phone
Police investigation number
If applicable.
Brokerage
(Required)
Broker Code
What's your name?
(Required)
First
Last
What's your email?
(Required)
What's your phone number?
×