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Home / Condo / Tenants Claims History Report

June 11, 2009

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:

________________________________________________________

COMPLETE MAILING ADDRESS:

__________________________________

__________________________________

__________________________________

__________________________________

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 _________________________________________________________________