claimreportform

Name *

Email *

Phone *

What type of claim are you reporting? *

Property Claim

Insured *

Loss Location *

Date of Loss *

Time of Loss

Description of Loss *

Policy Number *

Brokerage *

Broker Name *

Broker Email

Broker Phone *

Insured Contact Person *

Insured Contact Phone *

Would you like to submit any documents?

Liability Claim

Insured *

Location of Claim *

Date of Loss *

Time of Loss

Description of Loss *

Policy Number *

Brokerage *

Broker Name *

Broker Email

Broker Phone *

Insured Contact Person *

Insured Contact Phone *

Do you have third party information? *

Third Party Name *

Third Party Address *

Extent of injury *

Was there any witness information gathered? *

Witness Name *

Witness Email *

Witness Phone *

Relation to the *

Would you like to submit any documents?

Marine Claim

Insured *

Loss Location *

Date of Loss *

Time of Loss

Description of Loss *

Policy Number *

Brokerage *

Broker Name *

Broker Email

Broker Phone *

Insured Contact Person *

Insured Contact Phone *

Operator

Current location of the vessel

Was there any witness information gathered? *

Witness Name *

Witness Email *

Witness Phone *

Relation to the *

Would you like to submit any documents?

Sports Accident Claim

Click button below to download claim form for manual submission. Please email the completed form to newclaims@royalclaims.ca. Please attach all supporting documents to your email

International Benefits

Click button below to download claim form for manual submission. Please email the completed form to newclaims@royalclaims.ca. Please attach all supporting documents to your email