Report a Claim

If anyone is hurt or in danger, call 911 first.Then protect the property from more damage: shut off water or gas, cover openings, and keep receipts for emergency repairs. Don't throw away damaged items or broken parts until the adjuster has seen them.

Fill in what you know; we can get the rest later. Fields marked optional can be left blank.

01Who is reporting

Your name

Insured name on the policy

Phone

Your relationship to the insured

Preferred language

02Policy

Find these on your declarations page or ID card. If you don't have them, leave them blank.

Insurance company (optional)

Policy number (optional)

03What kind of claim?

Property damageWater, fire, smoke, wind, storm, theft or vandalism at a building Someone else was hurt or had damageA slip and fall, a tenant or customer claim, damage you caused Auto accidentCollision, theft or damage to a car or business vehicle Employee injuryA worker was hurt or got sick on the job Something elseLawsuit papers, a letter from an attorney, or not sure

04When and where

Date it happened

Time (approximate)

Address or location

What happened?

05Photos and documents

After you send this form, email photos of the damage, repair estimates, receipts and any police report or letters to claims@bestchampioninsurance.com, or fax them to 646.218.8762. Photos taken before cleanup help the claim the most.

I confirm this information is true to the best of my knowledge, and I agree that Best Champion Insurance Brokerage may report this claim to the insurance company on my behalf. Sending this form does not guarantee the claim will be covered.

Takes about 5 minutes.

01Who is reporting

02Policy

03What kind of claim?

04When and where

·Property damage details

·Injury or damage to someone else

·Auto accident details

·Employee injury details

·Other details

05Photos and documents