Report Other Claim Types

Use this form to report claims that concern first and third-party pollution liability, crime, cyber liability, member on-premises special event liability, and vendors/contractor liability.

  1. Complete the following form fully and accurately.
  2. Upload any documents.
  3. Click submit.
Member organization
Your email
Your Phone
Your name
Date of event
Third party responsible
No    Yes, include information below
Location of event
Witnesses
Law enforcement
Description of the event, including injuries or damage
Estimated loss amount