Submit a New Claim - PACIFIC WEST CLAIMS

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Use this form to securely upload new claim information. We’ll get to work right away.

Your Company

Your Name

Your Contact Phone

Your Email *

Your Claim Number

Type of Claim

Explanation of 'Other' Claim

Your Insured's Name

Your Insured's Address

Your Insured's Email

Your Insured's Phone

Claimant's Name

Claimant's Address

Claimant's Email

Claimant's Phone

Type of Assignment

Task Assignment Detailed Instructions

Property Claims

When would you like your first report?

File Upload

Click or drag files to this area to upload. You can upload up to 6 files.

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