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Submit a claim

You can file your claim online, quickly and easily, 24/7

General information

Insured Name

Policy Number

Property Address

Mailing Address

Primary Contact Phone No.

Secondary Contact Phone No.

Email

Are you the insured?

YesNo

Reported by

Relationship to insured

About the loss

Date of loss

Cause of loss

Describe the damage to your home

Is this loss due to a storm?

YesNo

Do you have any exterior damage to the home?

YesNo

Describe the exterior damage to your home

Is there an opening in the roof?

YesNo

Have temporary repairs been made or in the process of being made?

YesNo

Is there interior damage to your home?

YesNo

Number of rooms damaged

Is there any standing water?

YesNo

Has a mitigation company already been contacted?

YesNo

Mitigation company name

Mitigation company phone

Is the home livable?

YesNo

If not, what conditions make it uninhabitable

Is there damage to your personal property?

YesNo

Have you assigned your benefits to a contractor for this claim or have you signed any other agreements?

YesNo

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