Print Page Home
be advised that this is a generic claim form and may refer to several types of
coverages. This does not imply or suggest that your policy contains these
coverages. Should you have any questions regarding your coverages, please read
your policy carefully and/or consult your agent.
The following documentation is required on all claims. All items must be
Copy of your primary automobile insurance declarations page (this is the page that indicates
your applicable coverages and limits at the time of loss).
This original signed claim form. Photocopies or fax copies are not acceptable.
Original paid rental bill. Photocopies or fax copies are not acceptable.
Complete copy of your rental reimbursement policy.
For rental reimbursement due to theft or collision, please also submit the following:
If vehicle repairable, copy of primary insurance company estimate, and copy of
body shop repair bill showing date repairs began and were completed.
If vehicle is unrepairable, statement from primary insurance company
indicating your vehicle was deemed a total loss.
Copy of police report including narrative. Note: Driverís Exchange of
Information is not acceptable.
If there was no police report filed, please complete and return the Accident or theft Affidavit
form. You can find this form attached to the online claim form.
For rental reimbursement due to mechanical breakdown, please also complete and return the
Mechanical Breakdown Affidavit. This
document must be signed and notarized.
Note: some products provide for the daily rental
car charge only and do not include collision damage waivers, taxes, other
insurance, or any other fees or surcharges that may be incurred at the time of
rental. Please see your contract for specific coverage terms and conditions.
Click here for claim due to Collision
Click here for claim due to Comprehensive and/or Theft
Click here for claim due to Mechanical Breakdown (more than 250 miles from home)
Return all documentation to:
800 Yamato Rd, Suite#100.
Boca Raton, FL 33431