Your Préname/Name

Address

Postal Code/City

[Name of your insurer]

Address

Postal Code/City

Done so; [your city], on [précate the date].

Object : Déclaration de sinistre

Madam, Sir,

Holder of the [car or home insurance] N° [Numéro of the contract], I regret to inform you that on [specify date], [specify time], I was the victim of the following loss:

- My vehicle [Indicate make and model] [State the circumstances of the loss]. You will find enclosed a copy of the joint report as well as the description of the damage caused.

- I have noticed a water damage. [State the circumstances of the loss]. You will find enclosed a copy of the joint report as well as the report of the damage caused.

- I have noticed a burglary [specify the circumstances of the loss]. You will find enclosed the report of the complaint.

I would be grateful if you could arrange for your expert to contact me as soon as possible to quantify the amount of damage to be compensated.

[Your signature]