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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:

 
 
 
 
 
 
 
 
 
 

Details of Insurance (if known)

 
 
 
 
 
 
 

Details of Shipment (if known)

 
 
 
 
 

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