Your Wawanesa Insurance policy number is required to complete this claim form.
If this is a claim emergency, please call 1-844-929-2637. We're available 24/7.
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Your Information
Loss Information
Describe the Accident or Incident*
Other Party Information
Injuries
Other Party Vehicle Information
Vehicle Damages
Our Insured Information
Driver Of The Insured Vehicle
Injuries
Our Insured Vehicle Information
Vehicle Damages
Police Report
Was a police report or joint report obtained?
Other Parties
Are there additional Other Parties not reported above?*
How Many?
Solo Vehicle Loss - No Other Party Involved
Other Party 1 Information
Injuries
Other Party 1 Vehicle Information
Vehicle Damages
Other Party 2 Information
Injuries
Other Party 2 Vehicle Information
Vehicle Damages
Other Party 3 Information
Injuries
Other Party 3 Vehicle Information
Vehicle Damages
Other Party 4 Information
Injuries
Other Party 4 Vehicle Information
Vehicle Damages
Other Party 5 Information
Injuries
Other Party 5 Vehicle Information
Vehicle Damages
Passengers / Witnesses
Were there any passengers in any of the involved vehicles?*
How Many?
No passengers in any involved vehicles
Passenger 1 Information
Injuries
Passenger 2 Information
Injuries
Passenger 3 Information
Injuries
Passenger 4 Information
Injuries
Passenger 5 Information
Injuries
Were there any witnesses?*
How Many?
No Witness
Witness 1 Information
Injuries
Witness 2 Information
Injuries
Witness 3 Information
Injuries
Witness 4 Information
Injuries
Witness 5 Information
Injuries