Online Claim Submission Form

Please use the form below to fill in your information accurately, and a representative from MG Forensics will get back to you as soon as possible.

Company Name:
Name of Adjuster:
Phone Number:
Fax Number:
E-Mail:
Policy/Claim Number:
Date of Loss:
If you are unaware of certain Claimant info, please select the checkbox beside the corresponding text input box.
Claimant's Name:
Claimant's Occupation
Claimant's Phone #:
Claimant's Address:
Claimant's City:
Claimant's Province:
Claimant's Postal Code:
Claimant's Birthdate:
Representation:	Legal Representation Non-Legal Representation No Representation
Contact Name:
Firm Name:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
E-mail Address:
Optional Benefits Purchased:	None 600 800 1000
Collateral Benefits Available?	Yes No
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