E-notice of Claim

The E-notice of Claim service is available to ENCON's Professional Liability and Construction clients only. ENCON does not process claims for any of our Group and Retiree Benefits products.

To file a claim electronically, please fill out this form. Make sure you have answered all the questions to the best of your knowledge before submitting the form. Fields marked with an asterisk (*) are required fields.

I. Contact Information (for the person completing this form)

1. Today's date : August 24, 2016

2. Name of person reporting *

3. Relationship to Insured

4. Company name

5. Telephone number (include area code) *
 

6. Fax number (include area code)

7. Email address *
 

II. Insured Information

1. Name of Insured *
 

2. Insured contact person

3. Name of company or organization

4. Insured's mailing address *

Street 
City 
Province 
Postal Code 

5. Telephone number (include area code) *
 

6. Other telephone number (include area code)

7. Email address

8. Policy number (if known)

9. Policy type

10. Name of brokerage

III. General Claim Information

1. Describe the facts of this claim or the circumstances that may result in a claim.

2. Date of loss or alleged error or omission

3. Date you were first made aware of claim or circumstances which could give rise to a claim

4. How did you become aware of the claim or circumstances which could give rise to a claim?

If your claim involves a property loss, please complete questions 5 to 8. Otherwise, skip to section IV

5. Time of loss (Type 'A' or 'P' to switch a.m./p.m.)

6. Estimated value of loss

7. Other parties involved

8. Location of loss, if different from mailing address

Street
City
Province
Postal Code

IV. Claimant Information

1. Name of claimant

2. Address (if known)

Street
City
Province
Postal Code

3. Have you been served with a Writ of Summons, Statement of Claim or Introductory Motion?

4. If yes, date of service

V. Additional Information

Please check the appropriate box below if you are forwarding any supporting documents associated with this claim by email, fax or courier to ENCON Group Inc. Please be sure to include a copy of the Writ of Summons, Statement of Claim or Introductory Motion and other legal documents, if applicable. Please indicate if the documents pertain to a claim previously submitted via our website.

To forward any supporting electronic documents to this E-notice of Claim:

Attach it to this form
(Please limit the attachment size to 15 Mb)




Send separately via email
Send separately via fax
Send separately via courier or mail
I have no supporting electronic documents to submit

You will receive a confirmation email upon submission of the above form, and a claims analyst will contact you within two business days to discuss this notice. If you have not received a response from our Claims department within two business days, or if you have a question or comment, please contact our office immediately to speak to one of our claims analysts at 1-800-267-6684. Our regular business hours are 8:00 a.m. to 5:00 p.m. EST, Monday to Friday.