Report A Claim

Please complete the form below. If any of the required information (indicated by an * ) is not available, please type UNKNOWN except for required telephone numbers and zipcode. Click on the Report Claim button to start processing your claim. If you have any question(s), call us at 1-877-STAR-210.

Claim Reported By:

Insured’s Information:

Loss Information:

Accident Description:

Driver Information

Insured Vehicle:

Claimant 1 Information:
The person(s) you had the accident with.

Property Damage for Claimant 1:

Claimant 2 Information:

Property Damage for Claimant 2:

Injured Persons:

Witness or Passenger:


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