Professional Liability Insurance Claims

Language

USE OF PERSONAL INFORMATION
We wish to collect the following information, including some personal information, for the purpose of processing your claim. To learn more about how we handle personal information, please refer to our guideline (in French only) on this topic.

Part 1 – Important information to read before completing your claim

Before filling out the form, please carefully read the important informations relating to the claim and the CPA Order’s Fonds d’assurance responsabilité professionnelle.

Part 2 – Insured’s contact information

CPA Member

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Ext.

*Principal email

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory

Add another person

Number of people

Person 1 added

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Ext.

*Email address

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory

Person 2 added

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Ext.

*Email address

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory

Person 3 added

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Ext.

*Email address

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory

Person 4 added

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Ext.

*Email address

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory

Person 5 added

*First name

*Name

*Business address

Unit

*City

*Province

*Postal / Zip Code

*Country

*Telephone (work)

Extension

*Email address

Please re-enter to confirm.

Employer’s name, where applicable: not mandatory