Residential Claim

If this is a claim emergency, please call 1-844-929-2637. We're available 24/7.

Your Wawanesa Insurance policy number is required to complete this claim form.

Asterisks indicates a required field

There are errors in the form

Reporter Information

Who is reporting the claim?

First name

Last name

Reporters Contact Information: Please type at least one phone number below

Home phone number

Business phone number

ext.

Cell phone number

Email address

Loss Information

Wawanesa policy number

Date of loss

Time of loss

Describe the accident or incident

Other Party Information

First name

Last name

Address

City

Country

State

Zip code

Province

Postal code

Home phone number

Business phone number

Extension

Cell phone number

Wawanesa Insured Information

Is the insured the same person reporting the claim?

First name

Last name

Address

City

Country

State

Zip code

Province

Postal code

Please type at least one phone number below

Home phone number

Business phone number

Extension

Cell phone number

Loss Location

Same as insured's address

Address

City

Country

State

Zip code

Province

Postal code

Police Report

Was a police report obtained?
Police Report No Report

Mortgagee

Does the home have any mortgages? Yes No

No Mortgages

How many mortgages ?

Mortgage 1

Name

Address

City

Country

Province

Postal code

State

Zip code

Home phone number

Business phone number

Extension

Cell phone number

Mortgage 2

Name

Address

City

Country

Province

Postal code

State

Zip code

Home phone number

Business phone number

Extension

Cell phone number

Mortgage 3

Name

Address

City

Country

Province

Postal code

State

Zip code

Home phone number

Business phone number

Extension

Cell phone number

Mortgage 4

Name

Address

City

Country

Province

Postal code

State

Zip code

Home phone number

Business phone number

Extension

Cell phone number

Mortgage 5

Name

Address

City

Country

Province

Postal code

State

Zip code

Home phone number

Business phone number

Extension

Cell phone number

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