National General Home Insurance Claim

Step 1 of 4: Policyholder Contact Information

Policyholder Information

Policy Number *

First Name *

Last Name *

Address

City

State

ZIP Code

Email Address

What is the policyholder's primary phone number?

Extension

National General Insurance and its affiliated companies may need to contact you with information regarding your claim. Do we have permission to contact you via text messages at the phone number(s) you have provided to us? You are not required to authorize text messages as part of the claim handling process. Message and data rates may apply for text messages.

Yes No

Does the policyholder have an alternate phone number?

Yes No

Secondary Phone Ext.

* Required field.

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

National General Home Insurance Claim

Step 2 of 4: Loss Information

Reporter Name *

Email Address *

Phone Number *

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

Time*

What was the location of the incident?

Street Address*

City*

State*

ZIP Code

Was this loss weather related? *
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

Was anyone 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

First Name

Last Name

Address

City

State

ZIP Code

Email Address

Phone Number

Type of injury sustained

Injured Person #2

First Name

Last Name

Address

City *

State *

ZIP Code

Email Address

Phone Number

Type of injury sustained

* Required field.

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

National General Home Insurance Claim

Step 3 of 4: Other Party Information

Was there any damage to another person's property? *
Yes No

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

Other Party Information

First Name

Last Name

Address

City

State

ZIP Code

Email Address

What is the other party's primary phone number?

Ext.

Name of Other Party's Insurance Company

Policy Number

Claim Number

* Required field.

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

National General Home Insurance Claim

Step 4 of 4: Review and Submit

Reporter Information Edit

Reporter Name:

Reporter Email:

Reporter Phone:

Policyholder's Information Edit

Policy Number:

First Name:

Last Name:

Address:

City/State/Zip:

Email Address:

Primary Phone/Ext:

Secondary Phone/Ext:

Other Party Property Damage Edit

Other Party Property Damage:

First Name:

Last Name:

Address:

City/State/Zip:

Email Address:

Primary Phone/Ext:

Other Party Ins Co:

Policy Number:

Claim Number:

Loss Information Edit

Loss Date:

Loss Time:

Incident Location:

City/State/Zip:

Storm Related:

Police/Fire Response:

Police/Fire Department:

Police/Fire Report/Case Number:

Incident Description:

Injuries Edit

Injured Person #1

First Name:

Last Name:

Address:

City/State/Zip:

Email:

Phone Number:

Type of Injury:

Injured Person #2

Role:

First Name:

Last Name:

Address:

City/State/Zip:

Email:

Phone Number:

Type of Injury: