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Submit a Claim
Policy Number
*
Date of Loss
*
MM slash DD slash YYYY
Claim Amount
*
Order #
BOL#
*
Name of Insured
*
Contact Name
*
Email
*
Phone
*
Commodity
*
Notes
Motor Carrier or Broker Certificate of Insurance
Maximum File Size 5MB
Max. file size: 5 MB.
Commercial Invoice
Maximum File Size 5MB
Max. file size: 5 MB.
Packing list
Maximum File Size 5MB
Max. file size: 5 MB.
Consignment note
Maximum File Size 5MB
Max. file size: 5 MB.
Delivery Receipts or Written Confirmation of Non-Delivery From Carrier
Maximum File Size 5MB
Max. file size: 5 MB.
Policy Report in the Event of Theft, etc.
Maximum File Size 5MB
Max. file size: 5 MB.
Pictures of Damage
Maximum Number of Photos 10; Maximum File Size 15MB
Drop files here or
Select files
Max. file size: 15 MB, Max. files: 10.
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