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  File a Claim
We have added the ability to file auto & glass claims online... more...
  
Our Customers Contact Us Filing A Claim Home Loss? Auto Accidents Req. A Certificate
 
   
  For our customers convenience we have created a 1st notice claim form. Simply fill out the requested info and click "submit". If you make a mistake click "reset". Please try to give us as much information as possible. Sections marked with an * must be completed. If there is physical damage over $1,000 or anyone is injured you must by state law complete and submit the Operators Report of Motor Vehicle Accident to the RMV and the local police within 5 days of the accident (if you like you can fax it to us at our Pembroke office at 781-293-7943 or to our Plymouth office at 508-747-3036). You can get a copy of this form by clicking on the link above. The form is in Adobe PDF format.
 
  Note: This form does not replace contacting our agency verbally. This is a preliminary report designed to simply provide first notice of a loss and allow us to prepare a loss notice accordingly. We also ask that you call our office within 48 hours if you haven't heard from one of our customer service representatives.
   
 

 

Insured Information

Name
Street
City, State, Zip  State Zip  
Daytime Phone
Email Address



Contact Information
Contact Name 
(if different from above)
Best time to reach you
Telephone #
 (if different from above)



Accident Information

Location of Accident
 (City, State, Zip)
Description of Accident
Police Contacted? Yes No



Your Vehicle

Vehicle Description

Year:  
Make: 
Model:
 
Owner Information 
(if different from insured, name & address)



Other Party's Vehilce

Vehicle Description Year:
Make:
Model
 
License Plate #
Owner Information
(Name & Address)
Driver Information
 (Name & Address)



Comments

Any Additional Comments or Questions?