CLAIMS EXPERIENCE LETTER REQUEST
Dear Insurer,

Please consider this my formal request to obtain my claims or insurance experience letter as per my authorizations below. Please fax (877-367-0249) or email (admin@avidnorth.ca) a copy of my request at your earliest convenience. Thanks!

Email address *
Named Insured: *
Your answer
Address of Insured(Street/City/Prov/Postal): *
Your answer
Insurer ( Name of Insurance Company): *
Your answer
Policy Number (On documents or pink card): *
Your answer
Additional Driver Name or Co Insured:(If none please answer N/A or none) *
Your answer
I hereby deem I am the named insured or authorized representative of the named insured, I hereby declare this is my digital authorization and acceptance for my broker (Avid Insurance Group Inc & 5377 Nunavut Ltd) to secure a claims letter on my behalf *
Required
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Signed *
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