Filing a complaint

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Complaints Officer

Fields marked with (*) are mandatory.

Your contact information

Title*

Ms. Mr.

Contract No.*

First name*

Last name*

Home address

Address*

Apartment

City*

Province*

Postal code*

Téléphone

Email*

The product that is subject of the complaint

Auto Insurance Recreational Vehicle Insurance Home Insurance Commercial Insurance Surety Lines Other

Description*

Your broker's name

Name of the person who processed your file

Description of the complaint

Please explain the nature of your complaint including any harm you believe you have suffered. Indicate, in chronological order, the facts giving rise to your complaint. Include specific dates and times, as well as the names of people you dealt with. (Use an additional sheet, if necessary).*

By filling out this complaint form, what result or settlement do you hope to obtain? What is the solution you propose?*

Document

Please attach any documents that may provide further details on the current situation.

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