For more serious claims (car accidents, thefts from your home or car and personal injury), it is important that you contact the police. You should also get the names and phone numbers of all individuals involved in the accident as well as any witnesses. If your car accident is the result of a hit-and-run (ie. your car was damaged by an unknown vehicle while parked) it is important you report the claim to the police within 24 hours.

In order to ensure your claim is processed promptly and accurately, it is important that you enter all information that is requested and that you provide as much detail as possible in the description box.

If you are unsure of how to complete the form, have a question regarding your coverages or how the claim will be handled, please call our office during regular business hours.

Personal Information

First Name:		Last Name:
Policy Number:

Type of Policy:

SelectBusiness InsuranceCarMotorcycleBoatHouseCondoApartmentRental PropertySeasonal Property

Contact Information

E-mail address:
Home Telephone:
Office Telephone:	Ext:
Fax Number:
If you know the name of your Customer Service Representative, please enter here

Claim Information

When did your claim occur?: (dd/mm/yyyy)
What time?

If your automobile accident involved another vehicle, please complete the following:

Where did the incident occur (be as specific as possible)?

Please describe what happened and the type and amount of damage?

Name of other driver:
Phone number:
Drivers License Number:
Vehicle type (year, model and make):
Insurance Company:
Policy Number:

If the police were called, please provide the following information:
Police Officer's name:
Report number: