Vehicle Claims Form - South Easthope Mutual Insurance

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1-800-263-9987Monday-Friday, 8:30am - 4:30pm

Email UsDrop us a line anytime!

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Our Story
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Experience South Easthope

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Proudly Canadian since 1871

"*" indicates required fields

Report Your Automobile Claim Here

Please fill out the information, press submit and a South Easthope Mutual claims representative will follow up within one business day.

Insured’s Name*

Email*

Phone*

Policy #*

Date of loss/accident

MM slash DD slash YYYY

What vehicle were you driving? (year, make, model)*

Description of what happened*

Where is the vehicle now?*

Was the vehicle towed?*

Where is the vehicle now?

Police reference #/accident #

Were charges laid by police?

Emergency services attending (fire, ambulance)

Were there passengers in the vehicle?

Yes

No

If yes, how many and who?

Was anyone injured?

Yes

No

If yes, how many and who?

Did you receive a Motor Vehicle Collision Report?

Driver of Other Vehicle’s Information

Other Driver’s Name

Phone Number

Their Insurance Company

Their Policy #

License Plate #

Vehicle Make, Model, Year

Registered Owner Name

Address

Witness Name and Phone Number

Description of damage to other vehicle

Δ

Our Purpose

We provide personalized insurance services to meet our members’ needs in the communities we serve.

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Contact Info

Call Us 1-800-263-9987
62 Woodstock St S, Tavistock, ON N0B 2R0
Monday - Friday, 8:30am - 4:30pm; Saturday/Sunday closed
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Our Values

Respect, Honesty, Reliability, Loyalty and Community

Our Vision

A strong, fair and respected company meeting our members’ needs of tomorrow.

South Easthope Insurance
Our Story
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Experience South Easthope
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1-800-263-9987
info@southeasthope.com
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