SWI Claims Personal Lines Loss Notice

Policy Holder Information
Fields marked with a red star (*) are required.
Name*
First Last
Policy Number*
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Primary Phone Type*
Secondary Phone
Secondary Phone Type
Loss Information
Date Loss Occurred*
Date Format: MM slash DD slash YYYY
Time Loss Occurred*

: HH

MM
Type of Loss*
Loss Location #
Loss Type if Other
Loss Reported To*
Report Number
Where Did The Loss Occur*
Address Where Loss Occurred (If Different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Information
Upload a File
Drop files here or

Accepted file types: jpg, gif, png, pdf, tiff.
Upload up to 5 photos with your claim by clicking the "browse" button and locating photos on your device.
Tell Us Who To Contact Regarding This Claim*
When Is the Best Time to Contact This Person?*
Other Contact Details*
First Last
Other Contact Phone*
Who is Submitting the Claim?*
Submitter Email*
First & Last name (if other)*
Name of Agency (if applicable)
Claim Submission
PLEASE NOTE: You must click CONTINUE below to review your information and then submit before your claim is processed.
Comments
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Policy Holder Information