Submit a Claim

How to submit a claim:

1. Fill in the online Notice of Loss below

-OR-

2. Print Notice of Loss PDF, fill in required information and send directly to Palliser Insurance:

By fax: 306.955.4901
By email: info@palliserinsurance.com
By mail: Palliser Insurance
103 – 3502 Taylor St. E Saskatoon, SK S7H 5H9

Policy Item #	# of Acres	Crop Type	Qrt	Sec	Twn	Rge	Mer	Type of Damage	Stage of Growth

Add additional policy items by clicking the plus sign (⊕) icon at the end of the row. To remove a policy item, click the minus sign (⊖).

Town Nearest the Loss*
Residence Location
I reside in
Street Address
Quarter
Section
Township
Range
Meridian
Additional Insurance
The information below is required under the Provincial Insurance Act.
Do you have other insurance?*
- Yes
- No
Additional Insurance Information*
Company Amount Per Acre
Power of Attorney
In the event of my absence when your adjuster calls to make an appraisal of this claim, I would like to assign power of attorney*
- Yes
- No
I hear-by appoint
Name*
Of (nearest town)*
Phone*
to act for me and on my behalf in the adjustment of the said loss, and in that capacity to make proof of loss and to do all things required by me to done pursuant to the statutory conditions of the said policy, and I hereby ratify all that my said attorney may do in connection with such appraisal and adjustment.
Power of Attorney Confirmation*
- By checking this box I confirm the above power of attorney information.

Company	Amount Per Acre