File a Business Claim







    DPM Insurance Group Office Location

    Name of Your Broker


    Policy Holder Information

    Policy Number

    Company Name*

    Primary Contact Person

    Main Phone*

    Work Phone

    Email Address

    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

    Did any injuries result from the loss/accident? NoYes

    If yes, please provide names, addresses, phone numbers and the extent of the injuries


    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

    Wallaceburg Office

    403 Wellington St.
    Wallaceburg, ON N8A 2Y2

    Phone: 519-627-1777