Claims

FILE A CLAIM

Submit your claim information below. A specialist will follow up within 1 business day.

SHIELDPRO INSURANCE AGENCY INC

15388 Manderley St, Fishers, IN 46040

(317) 836-0081

Fields labeled in orange are required to set up a claim.

Loss Information

Date of Loss *

Time Approx *

Today's Date

Claim Type *

Our Customer Information

Insured *

Contact Name & Phone *

Truck

VIN # last 5 digits — in accident / hauling load (see notes)

VIN (last 5)

Year

Make

Damaged

YesNo

Trailer

VIN (last 5)

Year

Make

Damaged

YesNo

Loss Location

Hwy or Ave *

Nearest City *

State *

Police Report / Case #

Police Officer Name / ID / Phone

Driver

Name *

Lic # *

State Issued *

Date of Birth *

Phone # *

Date of Hire

Towing & Vehicle Location

Towing Company

Contact & Phone

Present Location of Damaged Vehicle

What Happened

Do Not Leave Blank *

For Cargo Claims — Cargo Type

ReeferDryOther

Other Party / Claimant Info

Injuries

YesNo

Name

Phone

Email / Fax

Driver Name

Lic #

DOB

Phone #

Other Party Insurance

Insurance Company

Claim #

Policy #

Phone

Fax

Witness Information

Attach witness statement if available.

Name

Phone

Email / Fax

Notes

1.Liability — There is damage to other vehicle, person or property
2.Physical Damage — Damage to your Truck or Trailer or Theft (Police Report required in Theft case)
3.Cargo — Documents needed: Bill of Lading, Load Inspection Report, Reefer maintenance documents; Commodity Hauled, Product location, Temperature download
4.Attach Police Report if possible
5.Attach Signed Driver Statement if possible — Must fill How the accident happened
6.Truck VIN # needed for Cargo/Reefer claims too. Date of Accident/Loss is Date Cargo Delivered/Damaged

Certification & Signature

I certify under penalty of perjury under the laws of the United States of America that the above information is true and correct.

Name of Person Filling the Form *

Email Address *