Transportation Risk Management Insurance Agency
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Transportation Claims Form (PDF)


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Agency- Transportation Risk Management
Agency Phone- (517) 896-2565
Agency Email- Curtis@transportationriskmanagement.com
Date of Loss
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Policy Information
Policy Number
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ZIP / Postal Code
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First Name
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Last Name
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Primary Phone Number
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E-Mail Address
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Claimant Name
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Phone Number
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E-Mail Address
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Facts of Loss
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VIN number
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Year/Make/Model
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Location
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VIN number
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Year/Make/Model
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Location
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Property Damage
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Property Damage Explained
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Any Injuries?
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Explain all Injuries
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Authorities Contacted?
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Authority and Report Number
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Any Additional Information
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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