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Create a Claim Report - Residential

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


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

* indicates a required field


    Your Information

    First Name*
    Last Name*
    Please type at least one phone number below *
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number
    Email Address
    Insurance Company Name
    Insurance Company Policy #

    Loss Information

    Our Policy Number* Help
    Date of Loss* (mm/dd/yyyy)
    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 ext.
    Cell Phone Number

    Our Insured Information

    Same as Your Information
    First Name*
    Last Name*
    Address
    City
    Country
    Province
    Postal Code
    State
    Zip Code
    Please type at least one phone number below*
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number

    Loss Location

    Same as insured's address
    Address
    City*
    Country
    Province*
    Postal Code
    State*
    Zip Code

    Police Report

    Was a police report obtained?


    Mortgagee

    Does the home have any mortgages?*


    How Many?

    No Mortgages


    Mortgage 1

    Name
    Address
    City
    Country
    State
    Zip Code
    Province
    Postal Code
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number

    Mortgage 2

    Name
    Address
    City
    Country
    State
    Zip Code
    Province
    Postal Code
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number

    Mortgage 3

    Name
    Address
    City
    Country
    State
    Zip Code
    Province
    Postal Code
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number

    Mortgage 4

    Name
    Address
    City
    Country
    State
    Zip Code
    Province
    Postal Code
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number

    Mortgage 5

    Name
    Address
    City
    Country
    State
    Zip Code
    Province
    Postal Code
    Home Phone Number
    Business Phone Number ext.
    Cell Phone Number


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