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Mundare 780-764-2238 Tofield 780-662-0165

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Submit an Insurance Claim

To report a new claim, please complete the following information:

Policy Holder First Name

Policy Holder Last Name

Policy Holder Address

Policy Number

Email

Are you the policy holder? *

Yes

No

If not the policy holder, what is your name?

What is your relationship with the policy holder?

Type of claim

Date of the accident or loss

Brief details of the claim

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