File a Claim | Venture General Agency

FILE A CLAIM

To file a claim, please complete and submit this form and a Venture General Agency agent will be in touch with you soon.

Step 1 - Personal Information

First Name

Last Name

Email Address

Mobile Phone

Home Phone

Home Address

Your Vehicle: YEAR, MAKE, MODEL

If, YES, what is your Venture policy number?

Venture Policy Number

If, NO, what is the name of the insured person?

Venture Insured Name

Step 2 - Accident Information

Date of Accident or Loss

Time of Accident or Loss

Location of Accident

Description of Accident

If, YES, tell us more about the injuries.

Description of Injuries

Damaged Area(s) on Vehicle

If, YES, please upload them below.

Upload Photo

Where is your vehicle currently located?

If, YES, please share police information.

Police Department

Police Report Number

Step 3 - Venture Insurance Information

Venture Policy Number

Venture Named Insured

Insured Vehicle: YEAR, MAKE, MODEL

Name of Insured Vehicle Driver

Phone Number of Insured Vehicle Driver

Name(s) of Insured Vehicle Passengers

Step 4 - Claimant Information

Claimant First Name

Claimant Last Name

Claimant Email Address

Claimant Phone

Claimant Address

Claimant Vehicle: YEAR, MAKE, MODEL

Name of Claimant Vehicle Driver

Phone Number of Claimant Vehicle Driver

Name(s) of Claimant Vehicle Passengers

Claimant Insurance Company

Claimant Insurance Policy Number

Step 5 - Witness Information

Witness #1 - First Name

Witness #1 - Last Name

Witness #1 - Email Address

Witness #1 - Phone Number

Witness #2 - First Name

Witness #2 - Last Name

Witness #2 - Email Address

Witness #2 - Phone Number

Witness #3 - First Name

Witness #3 - Last Name

Witness #3 - Email Address

Witness #3 - Phone Number

Thanks for submitting our claim form. An agent will be in touch with you soon.