New Claim

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Please fill out the form below. If you have any questions or wish to speak with an EIMC representative, please use our office locator tool.

CONTACT PERSON (required)

ADDRESS:

CITY:

STATE:

TELEPHONE NUMBER:

EMAIL ADDRESS (required)

INSURANCE INFORMATION

INSURANCE COMPANY:

CITY:

POLICY/CERTIFICATE NO.:

COUNTRY:

CARGO:

LOCATION OF CARGO:

CONTACT PERSON:

TELEPHONE NUMBER

VALUE OF SHIPMENT:

ESTIMATED LOSS AMOUNT:

ATTACH DOCUMENTS: