To receive your Home Insurance Claims History Report:
Print and complete the form below, then send your request by one of the options below:
- Fax: 514-415-3989
- Mail:
CGI Technical Assistance
1350 Rene-Levesque West, 7th Centre Floor
Montreal, PQ H3G 1T4
FULL NAMES OF HOME OWNERS:
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COMPLETE MAILING ADDRESS:
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__________________________________
__________________________________
__________________________________
PREVIOUS ADDRESS IF AT ABOVE ADDRESS LESS THAN FIVE YEARS:
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DAYTIME PHONE NUMBER: ___________________________________
DATES OF BIRTH FOR EACH HOMEOWNER:
MO_____ DAY _____ YEAR _____________
MO _____ DAY _____ YEAR _____________
Please provide me with a copy of my home/tenant/condo history report.
Thank you for your assistance.
Signatures:
X _________________________________________________________________
X _________________________________________________________________
