General Claims Form

Please fill in all known information on this form as well as a detailed description of the loss.

* Required fields

Insured Name *

Policy Number *

Email *

Phone Number *

Best Form of Contact *

Phone

Was a Police Report Filed? *

Yes

Date of Loss *

Time of Loss

Type of Claim *

Details of Incident: *

Human or Robot

Quick Links

40 Calhoun Street
Suite 215
Charleston, SC 29401
Office: 843-723-4001
Fax: 843-723-2120

PO Box 1487
465 Spruce Street
Walterboro, SC 29488
Office: 843-549-7777
Fax: 843-549-7563