POLICY SERVICE

REPORT A CLAIM

Some of the insurance carriers we represent have direct phone numbers where claims are to be reported. If the policy in question is written with any of the following companies, please report the claim directly to the number provided:

AXIS Surplus Insurance Co:	1.877.300.7017 (Earthquake and/or Landslide/Flood Claims)
Canal Insurance Company:	1.800.452.6911
Canal Indemnity Company:	1.800.452.6911
Scottsdale Insurance Company:	1.800.423.7675
Scottsdale Indemnity Company:	1.800.423.7675
National Casualty Insurance Co:	1.800.423.7675

If the policy in question is with a different carrier, you can either:

1. Complete the appropriate ACORD Claim Form to submit to us via fax or email:

• ACORD Property Loss Notice
• ACORD Liability Loss Notice
• ACORD Automobile Loss Notice

or

2. Fill in the information below, which will be emailed to claims@gogus.com, and a representative will contact you.

Your Information
So we know how to contact you if we have questions:

* First Name:
* Last Name:
* Email:
* Phone:

Insured's Information

* Policy Number:
* Named Insured:
Name of Contact Person:
Email:
Phone:
Secondary Phone:
Best time to contact:

Loss Information

* Date and Time of Loss:
* Location of Loss:
Claimant Name (if liability claim):
Were the police notified?:	Yes     No
If so, report number:

* Please describe the loss/damage/accident in detail, including contact info, vehicle info:

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