Claims

HOME HAHN AGENCY, INC.

Claims Reporting

Remember, when a loss occurs, please remember the following tips:

Do not admit fault.
Get name, telephone number and policy number of other party.
Make police report.

Please complete the form below in order to report a claim. We will call you once this information is received. This form is in three parts, General information, auto losses and home losses. Only the areas relevant to your loss are required to be completed.

General Information

Policyholder name
Policy Number (if available)
Date of Loss
Time of Loss
Person to Contact
Relationship to Insured
Business Telephone
Home Telephone
Best place available
Best time to call

Auto Loss Details - Use remarks section at end of form for details.

Town and State of Loss.
Police Report?
Police report #
Ticket issued to you?
Your vehicle
Injuries?

Home loss details. - Use remarks section at end of form for details.

Location of loss
Type of loss
Liability claim? (If liability claim, please fill in claimant information in "other party" section below)
Amount of loss.

Other party information - auto or liability claim.

Name
Address line 1
Address Line 2
Phone Number

Remarks

Please provide details for above questions and provide a description of the loss.

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