File a Property Claim






DPM Insurance Group Office Location

Name of Your Broker


Policy Holder Information

Policy Number

Name of Policy Holder*

Home Phone*

Work Phone

Primary Contact Person

Where should we contact you?

Best time to contact you?

Claim / Loss Information

Date of Loss or Accident*

Address

City

Province:

Please provide as much detail as possible regarding the claim in the space provided below. A representative will contact you shortly.

Police Contacted? YesNo

Officer's Name

Officer's Badge Number

Officer's Report Number


Form Completion

Blenheim Office

24 Marlborough St. N., Box 479
Blenheim, ON N0P1A0

Phone: 519-676-8159
Fax: 519-676-0020

Chatham Office

250 St. Clair St.
Chatham, ON N7L 3J9

Phone: 519-352-4343
Toll Free: 1-800-561-4949
Fax: 519-352-6484

Essex Office

29 Talbot St. N, Box 69
Essex, ON N8M 2Y1

Phone: 519-776-6457
Fax: 519-776-7400

Harrow Office

65 King St. W., Box 790
Harrow, ON N0R 1G0

Phone: 519-738-2277
Fax: 519-738-2279

Tilbury Office

59 Mill St. E, Box 1239
Tilbury, ON N0P 2L0

Phone: 519-682-0202
Fax: 519-682-2391