Adjuster's Fire Report | eServices Prince Edward Island

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15-01 as it relates directly to and is necessary for the Adjuster's Fire Report. If you have any questions about this collection of personal information, you may contact the Office of the Fire Marshal at 902-368-4869.

Identification

Is the insured an individual or a business/organization?

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

County

Date of Birth

Is the insured person or business the owner of the building or vehicle lost in the fire?

Owner Information

Is the owner an individual or business/organization?

Business/Organization Name

First Name

Middle Name(s)

Last Name