New Claim Submission – mimiclaims.com

new claim

Submitted By

Name

Phone Number

Company

Address

City

State / Province

Zip / Postal Code

Policy Number

Loss Information

Customer Claim Number

Brief Description of Loss

Date of Loss

Location of Loss

Insured Information

Insured Person / Company

Insured Name

Insured Address

City

State / Province

Zip / Postal Code

Contact Information

Insured Phone Number

Insured Email

Insured Vehicle Information

Vehicle Plate / Tag Number

Vehicle Make

VIN

Driver's Name

Driver's Phone Number

Damage Description

Attach Claim Documents