National General Auto Insurance Claim

Step 1: Policyholder Contact Information

Was anyone in the policyholder's vehicle injured?
Yes No

How many people were injured?

Please note: If you are reporting an accident with more than two vehicles or injuries, please call us directly at 1-800-468-3466 to report your claim.

Injured Person #1

This person was the:

First Name

Last Name

Address

Phone Number

Type of injury sustained

Injured Person #2

This person was the:

First Name

Last Name

Address

Phone Number

Type of injury sustained

Policyholder Information

First Name *

Last Name *

Email Address *

City *

State *

ZIP Code *

PrimaryPhone *
Ext.

Does the policyholder have an alternative phone number?

Yes No

Secondary Phone Ext.

Do you have the other party's information?
Yes No

* Data is not yet being submitted. You will have a chance to review your information before submitting.

National General Auto Insurance Claim

Step 2: Other Party Contact Information

Was anyone in the other party's vehicle injured?
Yes No

How many people were injured?

Please note: If you are reporting an accident with more than two vehicles or injuries, please call us directly at 1-800-468-3466 to report your claim.

Injured Person #1

This person was the:

First Name

Last Name

Address

Phone Number

Type of injury sustained

Injured Person #2

This person was the:

First Name

Last Name

Address

Phone Number

Type of injury sustained

Other Party Information

First Name *

Last Name *

Email Address *

City *

State *

ZIP Code *

What is the other party's primary phone number?*

Ext.

Name of Other Party's Insurance Company

Policy Number

Claim Number

* Data is not yet being submitted. You will have a chance to review your information before submitting.

National General Auto Insurance Claim

Step 3: Loss Information

What was the date and time of the loss?
Date*

Time*

What was the location of the incident?

Street Address*

City*

State *

Was this loss related to a recent storm?
Yes No

Please describe how the incident happened and any damages sustained.*

Did the police or fire department respond?
Yes No

Police/Fire Department Name

Police/Fire Department Report Number

* Data is not yet being submitted. You will have a chance to review your information before submitting.

National General Auto Insurance Claim

Step 5: Review and Submit

Policyholder's Information Edit

First Name:
Last Name:
Email Address:
City/State/Zip: ,
Primary Phone/Ext:
Secondary Phone/Ext:

Injured Person #1
Role:
First Name:
Last Name:
Address:
Phone Number:
Type of Injury:

Injured Person #2
Role:
First Name:
Last Name:
Address:
Phone Number:
Type of Injury:

Other Party's Information Edit

First Name:
Last Name:
Email Address:
City/State/Zip: ,
Primary Phone/Ext:
Secondary Phone/Ext:

Injured Person #1
Role:
First Name:
Last Name:
Address:
Phone Number:
Type of Injury:

Injured Person #2
Role:
First Name:
Last Name:
Address:
Phone Number:
Type of Injury:

Loss Information Edit

Loss Date:
Loss Time:
Incident Location:
City:
State:
Storm Related:
Police/Fire Response:
Police/Fire Department:
Police/Fire Phone Number:
Incident Description:

Property Damage Information Edit

Vehicle #1
Vehicle Owner:
Year:
Make:
License Plate:
Drivable:
Current Vehicle Location:
Incident Location:
Driver Name:
Vehicle used for delivery services:
Vehicle used for transportation services:

Vehicle #2
Vehicle Owner:
Year:
Make:
License Plate:
Drivable:
Current Vehicle Location:
Incident Location:
Driver Name:
Vehicle used for delivery services:
Vehicle used for transportation services:

National General Auto Insurance Claim

Step 1: Policyholder Contact Information

National General Auto Insurance Claim

Step 2: Other Party Contact Information

National General Auto Insurance Claim

Step 3: Loss Information

National General Auto Insurance Claim

Step 4: Property Damage Information

National General Auto Insurance Claim

Step 5: Review and Submit