Please complete the following form with as much information as possible. Your claim will be sent to our team and you will receive a confirmation email. We will be in touch with you as soon as possible.

Type of Claim*
- Collision with Injury/Death
- Fire
- Sinking
Today's date
Date Format: MM slash DD slash YYYY
Date of Loss
Date Format: MM slash DD slash YYYY
Time of Loss

: HH

MM
Name of Person Completing this form
First Last
Named Insured
Phone
Email*
Enter Email Confirm Email
Policy Number
Involved Vessel (Year/Make/Model)
Location of Loss (include closest city/state)
Briefly state what happened
Where is the vessel now?
Contact person at location
First Last
Phone
Is the vessel current
- Afloat
- Hauled
- In need of Salvage/Tow
What is damaged? (if known)
Additional Comments
Phone
This field is for validation purposes and should be left unchanged.