Dear Policyholder,
this Accident/Loss Report form should be filled out if your vehicle, which is insured with the Hand-in-Hand Group, has been involved in an accident.
Please note that your insurance contract requires you to notify us in writing, or as we are allowing, via the below form, and to give all information and assistance we may require.
Please complete and submit this Accident/Loss Report Form as soon as possible.
Remember, any letter, claim, writ, summons and/or process must be forwarded to this company immediately upon receipt. You must also immediately notify us in writing should you have knowledge of any impending prosecution in respect of this accident.
Failure to complete and submit this form may result in the loss of any benefits under the insurance policy.
Accident/Loss Report Form
PLEASE NOTE THIS ENTIRE FORM IS CONTAINED WITHIN THE FOUR (4) TABS IMMEDIATELY SHOWN BELOW. ALL FIELDS IN EACH TAB MUST BE FILLED OUT PRIOR TO SUBMITTING THE FORM. YOU MAY ENTER “N/A” IN ANY FIELD THAT IS NOT APPLICABLE.