Submit a Claim | Four Points Insurance

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This form is for commercial insurance claims. 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)

Insured Address(Required)

Street Address Address Line 2 City Province 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?

Claim Information

What kind of claim are you reporting?(Required)

Property

Liability

When did the loss happen?(Required)

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 Postal Code

Date loss reported to the broker(Required)

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.

Broker Information

Brokerage(Required)

Broker Code

What's your name?(Required)

First Last

What's your email?(Required)

What's your phone number?

Comments

This field is for validation purposes and should be left unchanged.