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Submit a Claim

To submit a new claim to the Williams & Partners team, please fill out the online form below or email us directly with your new claim referral at: claims@wpfa.ca

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Claimant Information

* Policy/Claim Number

* Date of loss

* Claimant's Name

Telephone

Address

City

Province

Postal Code

* Date of birth

Representation

What kind of representation do you have?

Legal representation Non-legal representation - Relationship No representation

Contact Name

Firm Name

Address

City

Province

Postal Code

Telephone

Fax

Email (optional)

Additional Information

Claim Type

AB Tort Other:

Policy Details

Optional benefits purchased:

None 600 800 1000

Collateral benefits available?

Yes No

Benefits paid to date?

Yes No

Documentation Received (Please forward to us)

Application for Accident Benefits (OCF-1/59) Employer's Confirmation of Income (OCF-2/59) Claimant's Signed Statement

Financial documentation (please list):