Auto Claim – FJ Torres Insurance

Automobile Preliminary Claim Form

Complete as much of the form as possible and click the Submit button at the bottom. We will be in touch with you for additional details as needed,

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Auto Claim Form

INITIAL CLAIMS INFORMATION - Auto Accident.
IMPORTANT REMINDER: You will need to complete an operators report for the Police and the Registry of Motor Vehicles.

Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Policy Number
Date of Loss*
MM slash DD slash YYYY
Time of Loss*

: Hours

Minutes

AM/PM
Vehicle*
Phone*
Email*
Description of Accident*
Describe Damage to Vehicle*
Is Vehicle Driveable*
Where is Vehicle*
Any Injuries*
Other Driver's Name
First Last
Other Driver's Address
Street Address City State ZIP Code
Other Driver's Phone
Other Driver's License Number
Other Driver's Date of Birth
MM slash DD slash YYYY
Other Vehicle's Owner
First Last
Other Vehicle Owner's Address
Street Address City State / Province / Region ZIP / Postal Code
Vehicle Owner's Phone
Other Vehicle - Year - Make - Model
Is Vehicle Driveable
Where is Damage to Other Vehicle
Property Damage to Other Than a Vehicle
Attach Any Related Paperwork
Drop files here or

Max. file size: 256 MB.

FJ TORRES INSURANCE

Dighton 508-669-6762 | Assonet 508-644-2152

Automobile Preliminary Claim Form

Auto Claim Form