Auto Loss Report Form

YesNo

Vehicle Information

Other Party Information

Criminal Information

YesNo

InsuredThird Party

Repair Statements

Please note: We require two (2) written repair statements.

SGI

SGI Appraisal Form and SGI Proof of Loss are only required if total damage is over $700.

By clicking submit, I agree that the foregoing statements are true and correct to the best of my knowledge, and are submitted as a claim under the said policy.