Kent Essex Mutual Logo

KENT & ESSEX MUTUAL INSURANCE CO.
250 St. Clair St., Box 356,
Chatham, Ontario, N7M 5K4

Tel: (519) 352-3190  Fax: (519) 352-5344


1-800-265-5206

 HOURS: Mon - Fri: 8:30 am - 4:30 pm

PRELIMINARY
PROPERTY
CLAIM
REPORT

   Date:
 Name of Insured:  Daytime Phone:
 Address:
  Evening Phone:
 Date of Loss:  E-mail Address:
 Location of Loss:  Policy #:
   Broker:
 Description of Loss or Damage:

 Additional Comments:

 Signature:

For your convenience, you may fill out this form on your computer, print it out and fax it to us at:
1-519-352-5344.