Auto 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.

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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

Extension

Cell phone number

Email address

Loss Information

Wawanesa policy number

Date of loss

Time of loss

Street/Freeway location

City

Country

Province

Describe the accident or incident

Wawanesa Insured Information

Is the insured the same person reporting the claim?

First name

Last name

Address

City

Country

Province

Postal code

Please type at least one phone number below

Home phone number

Business phone number

Extension

Cell phone number

Driver Information

Is the driver of the insured vehicle same as above?

Yes

No Driver

Unknown

Date of birth

Drivers license number

Describe any injuries suffered

Wawanesa Insured Vehicle

Vehicle year

Vehicle make

Vehicle model

Vehicle color

License plate

VIN

Vehicle damages

Police Report

Was a police report or joint report obtained?

Police Report

Joint Report

No Report

Other Parties

Are there additional other parties not reported above?

Yes

Solo Vehicle Loss - No Other Party Involved

Passengers / Witnesses

Were there any passengers in any of the involved vehicles?

Yes

No passengers in any involved vehicles

Were there any witnesses?

Yes

No Witness

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