By clicking submit, I hereby certify that I have the authority to make this request by being the insured or a representative of the insured.

Disclaimer: This claim will be reviewed and contact will be made as soon as possible on the next regular business day following receipt of this notice. We may not receive this promptly if the report is being completed after office hours or on weekends. This reporting capability is solely for the convenience of filing a claim after hours or when it is not feasible to contact your agent during normal business hours.

Fraud Statement: Any person who knowingly and with intent to defraud any insurance company or other person, files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact, material thereto, commits a fraudulent insurance act, which is a crime, is subject to criminal prosecution and civil penalties.