Submit Assignment Claim Number *Policy NumberType of ClaimSelect one of the followingCasualtyPropertyWorkers CompAttach DocumentChoose FileNo file chosenDelete uploaded fileInsured InformationNameStreet AddressCityStateZIPPhoneContact PartyClaimant InformationNameStreet AddressCityStateZIPPhoneContact PartyDate of LossLocation of LossDescriptionSpecial InstructionsCoverageYour InformationName *Street Address *CityStateZIPPhone *Contact Party *Email *Preferred Method of ReportingSelect one of the followingEmailFaxUS MailSubmit