Form

Claims Notice Form

For Use by Insurance Brokers Only

STOP: This form is only for the purpose of submitting a claim.

IF you require advice, service or any other requests, please contact us at brokersupport@apollocover.com.

If your client is APOLLO Policyholder with a claim you’d like to file, you’re in the right place. Please fill out this form and a representative will reach out to you to begin the process.

Broker Details

Brokerage Name

First Name

Last Name

Phone number

Email*

Insured Information

Insured Policy No

Insured Legal Name

Insured Mailing Address

Insured Mailing Province

Risk Address

Insured Claim - Risk Province

Loss notice Information

Claimant Contact Name

Claimant Phone No

Location of Loss

Date of Loss

Year/Month/Day

Time of Loss

Insured Claim - Loss Details

Please Attach Any Relevant Information

Additional Info for Claims Adjusters