Submit a Claim

insured information

Policy Number

Insured Name

Insured Contact Name

Insured Contact Phone

Insured Contact Email

Insurance Agent Name

Insurance Agent Phone

Insurance Agent Email

Name

Date of Loss (YYYY-MM-DD)

Loss Location (include street address if available)

Description of Loss

Vehicle Vin

Police Report Number and Reporting Agency (if applicable)

Witness Information (if available)

Current Location of Vehicle(s)

Fatalities?(required)

Yes No

If yes, please provide individual’s information

Injuries?(required)

Yes No

If yes, please provide individual’s information

Driver Name

Driver Phone

Driver Date of Birth (YYYY-MM-DD)

Driver DL / CDL #

Description of Cargo

Shipper Information

Consignee Information

That’s it! Send it over and we’ll take care of the rest.

Eventus Claims delivers innovative, reliable, and responsive claims solutions tailored to the needs of our clients and their customers.