How many at fault claims have you had in the last 3 years?
Vehicle Plate Number
Preferred method of contact E-mailPhone
Has your driver's licence been suspended during the last 5 years
How many traffic convictions have you had within the last 5 years?
What is your vehicle primarily used for? Personal or business use?
If applicable, please describe any commercial or business use of your vehicle:
I Agree: that Laroche Mcdonald Insurance is authorized to use my personal information from the Saskatchewan Auto Fund, including my driving history, claims history and insurance history for the purposes of evaluating my entitlement to automobile insurance. I understand that this personal information is necessary to assess the risk, issue the insurance contract, renewal, detect and prevent fraud and investigate and settle any claim. I authorize you to disclose all information Laroche Mcdonald Insurance collects for the purpose of evaluating my entitlement for insurance coverage to all insurance markets dealt with by Laroche Mcdonald Insurance.
Check to agree:
Your Name (required)
Your Email (required)
Your Phone Number
How would you prefer to be contacted? EmailPhone
Fill out this short form and we'll contact you.
Please include the date of your claim, the cause of your claim, and a brief description of your claim:
How would you prefer we contact you? EmailPhone
*Filling out this form does not file the claim automatically. We would like to speak with you directly first.*