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Report a Claim Questions

What is the National General Insurance policy number?
What is name of person reporting claim?
How were you involved in the loss? Claimant Agent Insured Other 
What is your e-mail address?
What is the policyholder's name?
What is policyholder's address?
Street address:
City:
State:
Zip code:
What is policyholder's telephone#? (555-555-5555)
What was the date and time of the loss? Date: Time:
(mm/dd/yyyy)(xx:xx AM/PM)
What was the location of the accident? (street, city, state)
Street address:
City:
State:
Please describe how the accident occurred?
Did the police respond?
If yes, Department name and police report?
Property damaged:
Insured vehicle:
Year
Make
Area of damage
Driver Name
Claimant vehicle:
Year
Make
Area of damage
Driver Name
Claimant name
Claimant Phone Number (555-555-5555)
Address
City
State
Zip Code
Any additional comments?
National General Insurance and its affiliated companies may need to contact you with information regarding your claim. Do we have permission to contact you via text messages at the phone number(s) you have provided to us? You are not required to authorize text messages as part of the claim handling process. Message and data rates may apply for text messages.  Yes    No