Submit a Claim

Your Contact Information

First Name

Last Name

Company

Address(Line 1)

Address(Line 2)

City

State/Province

ZIP / Postal Code

Phone #

Email Address *

New Assignment Information

Your Claim #

Special Instructions0 / 1000

Insured's Information

Your Claim #

Phone #

Alternative Phone #

Company

First Name

Last Name

Street Address

City

State/Province

ZIP / Postal Code

Mortgagee

Loss Location

Street Address

City

State/Province

ZIP / Postal Code

Claimant Information (if applicable)

First Name

Last Name

Phone

Street Address

City

State/Province

ZIP / Postal Code

Loss Information

Date of Loss

Type of LossAccident BenefitsAll PerilsAll Risk - BuildingAnimal ImpactAuto LiabilityAutomobileBodily InjuryBreak & EnterBuilders RiskBusiness InterruptionCollisionComprehensiveData LossContentsDirectors & Officers LiabilityEarthquakeElectrical CurrrentEnvironmentalEnvironmental Impairment LiabilityEquipment BreakdownEvent CancellationFireGlass BreakageHailHit and RunHole-in-OneIce DammingImpact by Falling TreeLiabilityBreach of PrivacyLegal ExpenseMotor Truck CargoMotor Vehicle AccidentMysterious DamageOthersMysterious DisappearanceProperty DamagePassenger HazardProfessional LiabilityPropertyRobberySewer BackupSlip and FallSmoke DamageTheftTornadoTrip and FallVandalismVehicle ImpactWaterWeight of snow loadWindFalling ObjectsPOEDSportsExplosionNOALightningOCIPCrimeMisrepresentationBoiler & MachineryEmployee DishonestyMechanical BreakdownCyber LiabilityNegligencePollutionSmokeRiot or civil unrestRiot or Civil UnrestTransit PerilsPhysical DamageWater DamagePersonal Injury

UnitResidential PropertyCommercial PropertyAutomobileCondominiumStrataFarm PropertySeasonal ResidenceProperty of Every DescriptionEquipmentCGLMarineMotorcycleChurchPrize IndemnityLegal ExpenseLiabilityWrap-Up LiabilityUmbrellaProfessional LiabilityContractors EquipmentCargoDirectors & OfficersBuilders RiskEnvironmental Impairment LiabilityCyberRisk Management SurveyEvent Cancellation

Type of AdjustmentLimitedFullTask

Loss Description0 / 1000

VIN #

Deductible

Save Assignment