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Auto claim reporting form

If you have an auto accident or another type of automobile loss, please fill out and submit the on-line form below. We will contact you shortly to start the claims adjustment process.
Customer Service:
800-287-8501
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assur
Auto Claim Form
 
Name:
 entry is required.
Address, include apt. #:
 entry is required.
City/State/Zip code:
 entry is required.
Phone (best for adjuster to call):
 entry is required.
Insurance carrier:
 entry is required.
Policy number:
Year, make, model of vehicle:
 entry is required.
Name of driver of your vehicle:
entry is required.
Date of accident:
 entry is required.
Location of accident:
 entry is required.
Description of accident:
 entry is required.
Year, Make, & model of other vehicle(s):
Plate #, or VIN of other vehicle(s):
Name/license# of other driver:
Witness information:
   
800-287-8501 • info@sgdins.com