Time of Loss:
Name of Operator:
Describe the Accident / Cause of Loss:
Esitmate of $ Loss:
Police Notified At:
Policy File Number:
If Yes, Against?:
Given Names and Addresses of Witnesses:
Please note: We require two (2) written repair statements.
Written Repair Statement 1:
Written Repair Statement 2:
SGI Appraisal Form and SGI Proof of Loss are only required if total damage is over $700.
SGI Appraisal Form:
SGI Proof of Loss:
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.