Report A Loss 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/DeathFireSinkingToday's date Date Format: MM slash DD slash YYYY Date of Loss Date Format: MM slash DD slash YYYY Time of Loss : HH MM AM PM Name of Person Completing this form First Last Named InsuredPhoneEmail* Enter Email Confirm Email Policy NumberInvolved Vessel (Year/Make/Model)Location of Loss (include closest city/state)Briefly state what happenedWhere is the vessel now?Contact person at location First Last PhoneIs the vessel current Afloat Hauled In need of Salvage/Tow What is damaged? (if known)Additional CommentsPhoneThis field is for validation purposes and should be left unchanged.