Indemnity - Claim Process

File a Claim

Claim Assignment Info Sheet (Please fill out completely to avoid delays)
Date of Loss		Are you insured through us? Yes No
Certificate Number		If no, then name of our customer
Your Name		Home Phone
Address		Business Phone
City	State	Zip
Vehicle Information
Year	Make	Model
Last six numbers of your VIN (vehicle identification number)		Color
Did you trade in a vehicle at the time of purchase? Yes No If yes, please provide the insurance company name:
Do you currently own another vehicle with existing insurance coverage? Yes No If yes, please provide the insurance company name:
Vehicle Location for the next 72 hours
Name		Voice Phone
Address		Contact Person
City	State	Zip
How did the accident happen?		Where did the accident occur?
Vehicle Damage Description