H.L. Staebler Company Limited

The Best Insurance Is An Insurance Broker

Forestry Equipment Insurance

Company Name:

Address:

City:

Province:

Postal Code:

Contact Person:

Email Address :

Phone Number:

Present Insurer:

Expiry Date:

	/		/
yyyy		mm		dd

How long have you been in business:

Loss/Claim history in last 5 years:

Equipment Schedule

Year:

Make:

Type:

Automatic CO2?

Yes

Limit of Insurance:

Commercial General Liability - Limit required

Forest Fire Fighting Expenses - Limit required

Disclaimer:

H.L. Staebler Company Limited is not responsible for instructions not received and acknowledged by a confirmation via e-mail or phone call. By submitting this form, you acknowledge that you are the policyholder and the events described on this form are truthful. Only the person named as the insured in the policy documents can submit a claim report on this policy. All policy terms and conditions apply, subject to policy status at time of submission.