Report A Claim

Please provide detailed loss information to expedite the claim handling process for your insureds. Supporting files such as the appropriate ACORD claim form, documentation and images can be attached at bottom of this form. All claims are handled by our carriers. The carrier claims departments will make contact in a timely manner.

Agency Contact Information:
First Name:*
Last Name:*
Agency Name:*
Phone Number:*
E-mail:*
Report A Claim For:
Name of Insured:*
Policy Number:*
Address:*
City/ZIP:*
Phone:*
Email:*
Jencap Entity:*
Date of Loss:
MM slash DD slash YYYY
Type of Loss:*
Loss Description:*
Upload ACORD Form/Incident Report Form and Any Other Relevant Documents:
Max. file size: 50 MB.
*Please refer to your policy for specific claim reporting requirements*
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Report A Claim

Agency Contact Information:

Report A Claim For: