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By using this service, you can expedite the handling of your claim.  After you complete the notice, it is sent electronically to the appropriate claims department personnel who will contact you within 24 hours.  For more information visit the Claim Notification Center.

Management and Professional Liability

 
    required  Denotes Required Fields
Contact Information
Name of Person Reporting the Claim/Circumstance required
Phone Number of Person Reporting Claim/Circumstance required  -  -

Email Address of Person Reporting Claim/Circumstance required
Name of Person to Contact required
Email Address of Person to Contact required
Phone Number of Person to Contact required  -  -

Policy Profile Policy Number  
Policy Holder Name (individual or company) required
Policy Holder Street Address  
Policy Holder City  
Policy Holder State required
Policy Holder Phone    -  -

Description of Claim/Circumstance Date of Loss required
Description of Loss/ What is alleged? required
Claimant/ Client Name
Claimant/ Client Contact Information
Suit Information Has Suit been filed? required
If Yes, Date Served required
Venue  
File Attachments  
Following packages will be used to scan file(s):
* McAfee VirusScan Enterprise
Allowed file types:
  .doc .docx .pdf .jpg .jpeg .gif .bmp .png .tif .rar .zip .xls .xlsx

File size is limited to 3 (MB) per file. Maximum Files: 5 
Submit Claim Form Here
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