Report a Claim

Complete the form below to report your loss, and a member of our Claims team will be in touch to assist you.

Alert If this is an emergency, please call 1-888-693-2253.

Please submit all Abuse Claims to our confidential claims e-mail at confidentialclaims@ecclesiastical.ca.

Reference Number
Form Choice
- Property or Liability Claim
If you have issues completing the Property or Liability Claims form below, please submit your claim to claimsservices@ecclesiastical.ca
I am a*
- Broker
- Insured
- Other/Third Party
First Name *

First name of the person who is reporting the loss
Last Name *

Last name of the person who is reporting the loss
Phone Number *
Phone number of the person who is reporting the loss
Email Address *

Email of the person who is reporting the loss
Contact Details
Copy Fields
- Contact details are the same as above
Claim contact - First Name*

First name of the individual who can be contacted with regards to the claim
Claim contact - Last Name*

Last name of the individual who can be contacted with regards to the claim
Claim contact - Phone Number*
Phone number for claim related correspondence
Claim contact - Email Address *

Email for claim related correspondence
Broker Details
Copy Fields
- Contact details are the same as above
Broker Name*
First Name *
Last Name *
Phone Number*
Email Address *
Insured Details
Organization Name*

Insured organization name
Policy Number

Policy number that covers the insured. Providing this will help us find your information faster.
Program Name

If covered under a program, provide program name
Certificate Number

If covered under a program, provide certificate number if known
Claim Details
Date of Loss*
MM slash DD slash YYYY

Date of incident
Loss Location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Description of Loss *
Hidden
Attachments (if applicable - pdf, xls, doc, jpg - Max 10 MB)
Accepted file types: pdf, xl, xls, doc, docx, jpg, Max. file size: 10 MB.
Attachments (if applicable - pdf, xls, doc, jpg - Max 10 MB)
Drop files here or

Accepted file types: pdf, xl, xls, doc, docx, jpg, Max. file size: 10 MB, Max. files: 20.
Please review your information before submitting. If this is an abuse claim ONLY provide your contact details so we can get back to you respecting confidentiality and privacy.

If your claim was not resolved to your satisfaction, please contact our Office of the Ombudsman to have your case reviewed: ombudsman@ecclesiastical.ca.

We are committed to the privacy and confidentiality of personal information. We collect, use and disclose personal information in accordance with applicable law. The personal information collected on this form will be used to handle and investigate the insurance claim.

Complete the form below to report your loss, and a member of our Claims team will be in touch to assist you.

Alert If this is an emergency, please call 1-888-693-2253.

Contact Details

Broker Details

Insured Details

Claim Details

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