Notice Of Loss View Notice of Loss PDF A NOTICE OF LOSS must be submitted within 3 days after damage to crop. Notice to local agent is not sufficient. Send a notice direct to the office issuing the policy whose address is printed above. Any letter form of reporting a hail loss is acceptable. Any notice filed after 3 days may be subject to a surcharge penalty. This form supplied for your convenience.Name of Applicant*Address*City*Province*SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonTelephone*Other PhoneEmail Power of AttorneyPhoneToday's Date* Month Day Year Please take notice that the following crops insured under the above policy were damaged by hail on:Date Month Day Year Time : Hours Minutes AM PM AM/PM Town Nearest the LossItem No.*# of Acres*Grain*Quarter*Section*Township*Range*Meridian*Damage Type*LightMediumHeavyStage of growth when hailed*Item No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedItem No.# of AcresGrainQuarterSectionTownshipRangeMeridianDamage TypeLightMediumHeavyStage of growth when hailedI reside in the following quarterof sectiontownshiprangeNote - I am aware that, according to the policy under which I am making claim, that if, for any reason, the insurer is not liable for loss, then I am liable for the expense incurred by the insurer for investigating said claim, and on demand, I promise to pay the insurer all such expense.THE INFORMATION BELOW IS REQUIRED UNDER THE PROVINCIAL INSURANCE ACTCompanyOther hail insurance on same cropsAmount per acreCompanyOther hail insurance on same cropsAmount per acreCompanyOther hail insurance on same cropsAmount per acrePhoneThis field is for validation purposes and should be left unchanged.
