Home / Condo / Tenants Claims History Report

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 Assistance1350 Rene-Levesque West, 7th Centre FloorMontreal, 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 _________________________________________________________________