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Roadside Refund Claim Form - CAA South Central Ontario

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    Member Details

    All fields are required unless marked optional.

    Format: 16-digit number

    Format: L#L #L#

    Format: xxx-xxx-xxxx

    Format: name@url.com

    Vehicle Details


    Facility/Service Details

    (Optional) Format: xxx-xxx-xxxx

    Format: MM/DD/YYYY

    Format: HH:MM

    (Optional) Format: HH:MM

    (Optional) Format: HH:MM

    Format: Street address, City, Province/ State and Country name

    Format: xxx-xxx-xxxx

    Format: xxx-xxx-xxxx

    (Optional)


    Whether an accident tow or not, please complete the following:

    (Optional)

    Emergency Road Service Terms & Conditions

    Supporting Documents

    Please upload any applicable documents (PDF, JPG, JPEG and PNG):

    1. Receipts
    2. Membership Card
    3. Letter from your insurer confirming they will not be covering the claim
    4. Corresponding incident report / provide report number
    5. Police Report
    6. Insurance Slip
    7. Applicable documentation from a government-authorized tow provider
    Note: If your total files size exceeds 20 MB your reimbursement request will not be processed. The max number of files allowed is 10.
    Please upload any applicable documents in any of the following format: PDF, JPG, JPEG and PNG
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    2 mb
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    reciept.jpg
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    reciept.jpg
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    (Optional)

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