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.