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Welcome to the property and Casualty Claim Starter form. Please follow the instructions to complete the necessary information on-line. When you are finished the form will be forwarded to the claim department. A claim service representative will contact you to discuss the details and explain the claim process.
* Required Field
1. Claim Information
Is this a personal or a business claim?
Personal Claim
Business Claim
Please select the type of claim.
Automotive
Home/Building
Bodily Injury/Property Damage
Worker's Compensation
Other
Other, explain:
Are you insured with Hanson & Ryan?
Yes
No
2. Personal Information
Name*:
Address*:
City*:
State*:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
Zip Code*:
Best to Contact Via*:
SELECT ONE
Home Phone
Work Phone
Cell Phone
E-Mail Address
When to Contact*:
3. Additional Information
Date of Loss*:
Location of Loss(City/State)*:
Reported to Authorities?*:
Yes
No
Loss Description*:
Damage Description:
Injury Description:
4. Additional Comments
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Hanson & Ryan Inc. • 87 Lackawanna Ave. • PO Box 347 • Totowa, NJ 07511-0347 • Phone: 973.256.6000 • Fax: 973.256.4788