Home  |  Submit Dispatching Form Submit Dispatching Form Complete the form below to submit your claim. Required fields are bold. Company Information First Name Last Name Company Address Suite City Province Postal Code Phone Number Email Address Claim Information Policy Claim Our File No. Insured Address Phone Vehicle VIN Date of Loss Month... January February March April May June July August September October November December Day...01020304050607080910111213141516171819202122232425262728293031 Year...201020112012201320142015 Vehicle Location Damage Deductible Deduct All Taxes Deduct 10% from Parts and Labour 1111715 ONT. INC. | 997 Roundelay Drive, Oshawa, ON, L1J 7S5 | 416-299-8006 | FAX 416-299-0101