To receive your Claims History Report:
Send your request by one of the options below:
Fax: 514-415-3989
Mail:
CGI Technical Assistance
1350 Rene-Levesque West, 7th Centre Floor
Montreal, PQ H3G 1T4
| FULL NAMES OF HOME OWNERS |
________________________________________________________ ________________________________________________________ |
| COMPLETE MAILING ADDRESS |
________________________________________________________ ________________________________________________________ |
| PREVIOUS ADDRESS IF AT ABOVE ADDRESS LESS THAN FIVE YEARS |
________________________________________________________ ________________________________________________________ |
| DAYTIME PHONE NUMBER |
| ________________________________________________________ |
| DATES OF BIRTH FOR EACH HOMEOWNER |
MO_____ DAY _____ YEAR _____________ MO_____ DAY _____ YEAR _____________ |
| Please provide me with a copy of my home/tenant/condo history report. Thank you for your assistance. |
X ____________________________________________________________________ X ____________________________________________________________________ |