Property (1st Party Property, Inland Marine, Equipment Breakdown)

ONLINE CLAIM SUBMISSION

Property (1st Party Property, Inland Marine, Equipment Breakdown)

To report your claim online, please complete all applicable fields.
When you have finished entering your data, please be sure to press the ‘Submit’ button to send your information.

After pressing the ‘Submit’ button, a copy of your claim will be emailed to you.

Please Note: Once your claim has been reviewed, we will contact you directly to obtain additional information.

Insured

Named Insured
Policy#
Insured’s Address 1
Address 2
City
State
Zip Code

Contact Information

Contact Person for Insured
Phone #
Cell Phone #
Email Address*
Name of Person reporting claim
Phone #
Cell Phone #
Email Address

Loss Information

Date of Loss
Time of Loss
Location of Loss Address 1
Address 2
City
State
Zip Code
Type of Loss
Brief description of loss and property damaged
Police/Fire Department information
Probable amount of loss ($$)

Remarks

Comments
* Please submit all claim documents (e.g., Charge of Discrimination, Due Process Hearing Request, attorney’s letter, Summons & Complaint, Notice of Tort Claim, or any similar document). Failure to submit relevant documents may delay the processing of your claim.