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Reporting a Claim/Accident Form | All Safe Insurance

Reporting a Claim/Accident Form

  1. MAKE THE AREA SAFE TO PREVENT ADDITIONAL PROPERTY DAMAGE OR INJURY TO OTHERS.
  2. CALL OUR OFFICE IF YOU NEED IMMEDIATE ASSISTANCE OR TO DISCUSS COVERAGE OR DEDUCTIBLES (305-262-5244)
  3. DO NOT DISCUSS ACCIDENTS WITH ANYONE
  4. DO NOT ADMIT FAULT
  5. DO NOT GIVE YOUR POLICY INFORMATION TO ANYONE ELSE. DIRECT THEM TO CONTACT OUR OFFICE OR THE INSURANCE COMPANY DIRECTLY.
  6. TAKE LOTS OF PICTURES
  7. GET NAMES AND PHONE NUMBERS FOR ANY WITNESSES
  8. KEEP RECEIPTS FOR ANY REPAIRS MADE
  9. COMPLETE THIS FORM AND FAX OR EMAIL TO OUR OFFICES.
Report a Claim/Accident
Title:
Your Name*:
Company Name:
Your Address*:
City, State & ZipCode*:
Best way to contact you:
Best time to call:
Telephone number:
E-mail address*:
Re-enter E-mail address*:
Location of Accident:
City State Zip of Accident:
Date of Accident:
Time of Accident:
Insurance Policy Company:
Policy #:
Police Repot #:
Explain what happened in detail::
Attachment:
captcha
Type Code*:


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