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Fill out as completely as possible and click Submit to send the loss report to our Marine and Transportation Specialty Claims Unit (MATSCU). Alternately, you can print this page, complete the form and fax it to the MATSCU at 1-877-629-6905.

Claim Reported By:

Relationship to Assured:

Details of Insurance (if known)


Details of Shipment (if known)

Has a surveyor been assigned?
Has carrier been notified of claim?

Contact Person for Further Details (if other than individual shown at top):


If you are a California resident, please read our Notice at Collection.