Report A Loss

We Are Here To Help!

If you would like to report a loss or get assistance from BELFOR Canada, please complete the online form below. Please provide as many details as you can. A BELFOR representative will respond as quickly as possible.

If you are a professional in the insurance industry, please complete the section For Insurance Professionals only.

If you need immediate assistance, please call 866.366.0493.

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First Name

Last Name

Primary Phone Number

Alternate Phone Number

Are you the property owner?

Is this an emergency?

Company

Email Address

Are you an Insurance professional?

Property Owner Name

Address of Damaged Property #1

Address of Damaged Property #2

City

Province

Postal Code

Country

Name of Insurance Carrier

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Loss Type

Loss Location Type

Date of Loss

Check All That Apply

How did you hear about BELFOR?

Special Instructions

FOR INSURANCE PROFESSIONALS ONLY

Approximate Square Feet of Structural Damage

Description of Loss

Rooms Affected

Materials Affected

Please Describe Contents Damaged In Loss

Has Insurance Company Been Notified

Insurance Claim Number

Name of Insurance Adjuster

Insurance Adjuster Phone

Name of Insurance Agent/Broker

Insurance Agent/Broker Phone

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