Auto Insurance Claim Checklist
Use this checklist to ensure you provide all necessary information and documents for your auto insurance claim.
Full Name
*
First Name
Last Name
Contact Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Policy Number
*
Date and Time of Incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Brief Description of the Incident
*
Were other vehicles involved?
*
Yes
No
Police Report Filed?
*
Yes
No
Police Report Number (if applicable)
Upload Photos of Damage
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Supporting Documents (e.g., repair estimates, police report)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Checklist: Please confirm you have included the following
Copy of insurance policy
Photos of vehicle damage
Police report (if applicable)
Repair estimate
Contact information for all parties involved
Submit Checklist
Should be Empty: