BAA CA Claim Form Brotherhood Auto Aid Canada Claim Form Section A - Policyholder Information Name * Email Telephone * Mobile Fax Address * City * Province * ABBCMBNBNLNSNTNUONPEQCSKYT PC * Date of Loss * Name of Driver * Age * Was the driver properly licensed? * Yes No Section B - Vehicle Information Policy Number * Year * Make * Model * Trim VIN (17 characters) * Is there a lien against this vehicle? * Yes No Kilometers * Name of Lien Holder Section C - Comprehensive Claim Glass Glass Flood Fire Fire Hail Theft Theft Storm Hit & Run Hit & Run Vandalism Animal Collision Animal Collision Projectile Section D - Collision Claim Was this a single vehicle or a multi-vehicle incident? * Single Multiple How did the accident happen? Need more room? Upload Document Drop a file here or click to upload Choose File Maximum file size: 15MB Who was at fault in this accident? * You Other Party Was the incident reported to the authorities? * Yes No Is your liability company responsible for damage to the other party's vehicle? Yes No Please provide the Name, Address, and Age of the other party involved. * Have you tried to obtain payment from the other party's liability? Yes No Please Explain * To what extent? Section E - Claim amounts TWO ESTIMATES ARE REQUIRED FOR LOSSES WITH THE FOLLOWING EXCEPTIONS: (1) the shop is owned by our brethren, or (2) the claim is less than $2,500.00, or (3) it is a glass claim. If it is impossible to obtain two estimates, please discuss the claim with the office personnel before the claim is filed. BAA will pay the lowest bid per rules and regulations. Checks will be issued to the policyholder unless other arrangements have been made. Non-Licensed drivers on public roads are not eligible for BAA Coverage. Please list estimate amounts. Estimate 1 $ Estimate 2 $ Please list salvage bids if total loss. Salvage Bid 1 $ Salvage Bid 2 $ Please upload the complete estimates with this claim report to Brotherhood Auto Aid. Signature of Applicant * signature keyboard Clear Estimates Upload Drop a file here or click to upload Choose File Maximum file size: 15MB If you are human, leave this field blank.