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About Us
- About Waldorf Risk Solutions
- Managing Partners
Services
- Risk Management Process
- Insurance Brokering and Advisory Services
Our Clients
Customer Service
News
Contact Us
Client Access

CSR24 Portal
Claims
Access Forms
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Home
About Us
- About Waldorf Risk Solutions
- Managing Partners
Services
- Risk Management Process
- Insurance Brokering and Advisory Services
Our Clients
Customer Service
News
Contact Us
Client Access

Customer Service

Forms

Claims - Auto, Property, Liability

How do I report a claim?

Each insurance carrier provides 24-hour claim reporting service; instructions are enclosed in your policy. As an alternative, you may complete our online claim reporting form and we will report to the insurance carrier on your behalf.

Fill out one of the following forms to submit your Auto, Property or Liability Claim.

Select A Form
Select A Form
- Automobile Claims Report
- Property Claims Report
- Liability Claims Report
Insured's Information
Insured's Name
Group Name (If Applicable)

If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.
Your Name
Your Phone Number
Email Address*
Address as it appears on the Registration
Street Address Address Line 2 City State ZIP Code
Accident Information
Driver's Name
Driver's Phone Number
Date of Loss
Month
Day
Year
Time of Accident
Location of Accident
Address
Street Address Address Line 2 City State ZIP Code
Description of Accident
Damage
Your Vehicle
Year
Make & Model
VIN Number
Plate Number
Repair shop information:
Name
Phone Number
Other Vehicle
Year
Make & Model
VIN Number
Plate Number
Other Driver's Name
Other Driver's Phone Number
Other Driver's Full Address
Street Address Address Line 2 City State ZIP Code
Damage
Carrier Name and/or Agent
Policy Number
Additional Information
Injuries
Were there any injuries? If so, please include the name(s), address and phone number of any injured parties.
Passengers/Witnesses
Were there any passengers or witnesses? If so, please include the name(s), address and phone number is possible.
Was an authority contacted?
- Yes
- No
Authority Info
If YES, please provide the accident report number and any other relevant details.
Additional Notes
Loss Information
Date of Loss
Month
Day
Year
Time
Location
Street Address Address Line 2 City State ZIP Code
Estimate of Damages
Description of Loss
Claimant Information
Claimant's Name
First Last
Claimant's Phone Number
Location
Street Address Address Line 2 City State ZIP Code
Description of Incident
Additional Notes
CAPTCHA

Adding and Deleting Automobiles and Drivers

How do I add/delete a vehicle or a driver?

You may fill our one more more of the following auto change request forms to submit for processing and we will contact you in the event additional information is needed

All Auto and Driver Add or Delete Forms

Select A Form
Select a Form
- Auto Addition (New Plates)
- Auto Addition (Delete & Replace)
- Automobile Deletion
- Driver Addition
- Driver Deletion
Insured's Information
Insured's Name
Group Name (If Applicable)

If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.
Your Name
Your Phone Number
Email Address*
Vehicle Deletion Information
Year
Make & Model
VIN Number
Termination Date
Month
Day
Year

Please note that if you are returning plates in either New York or Massachusetts, a copy of the plate return receipt must be submitted to our office. You may forward it by either fax or e-mail for the most prompt response, or by regular mail.
Additional Notes
Vehicle Addition Information
Year
Make & Model
VIN Number
Cost New
Passenger Capacity
Replacement Vehicle/Addition Information
Year
Make & Model
VIN Number
Cost New
Passenger Capacity
Are the plates being transferred from the old vehicle to the new one?
- Yes
- No
Registration Information
Addition Date
Month
Day
Year
Delete & Replace Date
Month
Day
Year
State in which the vehicle will be registered
Name as appears on the Registration
Address as it appears on the Registration
Street Address Address Line 2 City State ZIP Code
Effective date as it appears on Registration
Month
Day
Year
Principle garaging location (city & state)
Leasing/Loan Information
Leasing Company or Bank
If the vehicle is leased and/or is a loan on it, please provide the name and address of the leasing company or bank:
Additional Notes
Please include any information about after market equipment, such as whellchair lifts, plows, etc.
New Driver Information
Name
First Last
Date of Birth
Month
Day
Year
License Number
State of Issue
Termination Date
Month
Day
Year
Additional Notes
If you would like to receive a copy of this completed form, please enter a valid e-mail address.
Driver Deletion
Name
First Last
Termination Date
Month
Day
Year
Additional Notes
CAPTCHA

Adding and Deleting Properties

How can I add/delete or make amendments to a property?

We have made adding or deleting a property easy. Just complete one of our property change request forms for processing

All Property Forms

Select A Form
Select A Form
- Property Addition
- Property Deletion
- Make an Amendment to an Existing Building
- Course of Construction
Insured's Information
Insured's Name
Group Name (If Applicable)

If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.
Email Address*
Your Phone Number
Your Name
Insured's Address
Street Address Address Line 2 City State ZIP Code
Addition Information
Addition Date
Month
Day
Year
Address
Street Address Address Line 2 City State ZIP Code
Deletion Information
Deletion Date
Month
Day
Year
Address
Street Address Address Line 2 City State ZIP Code
Was this building owned or leased?
- Owned
- Leased
Occupancy/Type of Building (ex: Dwelling, Church, Hall, Kitchen, etc.)
If Occupancy/Type of Building is a school, please provide the following information.
Number of Students
Number of Teachers
Age Range
Additional Notes
Amending Limits and/or Contents of An Existing Building
Date of Change
Month
Day
Year
Current Address
Street Address Address Line 2 City State ZIP Code
Is the building owned or leased?
- Owned
- Leased
Changes
Please describe the change(s) being made to your existing location (i.e. address change, change in limits, etc.)
Reasons for Change(s)
Additional Notes
Leasing/Loan Information
Leasing Company or Bank
If the vehicle is leased and/or is a loan on it, please provide the name and address of the leasing company or bank:
Additional Notes
Please include any information about after market equipment, such as whellchair lifts, plows, etc.
Building Information
Please Select One
- New Building
- Renovation
- Addition to Existing Building
Estimated Start Date
Month
Day
Year
Estimated Completion Date
Month
Day
Year
Address of Construction Site
Street Address Address Line 2 City State ZIP Code
Proposed Occupancy/Type of Building

(ex: Dwelling, Church, Hall, Kitchen,etc.)
Project Name/Description
Construction Type
Please indicate percentage; indicate '0' if not applicable or unknown.
Frame %
Please enter a number from 0 to 100.
Noncombustible/Metal %
Please enter a number from 0 to 100.
Modified Fire Resistive %
Please enter a number from 0 to 100.
Joisted Masonry %
Please enter a number from 0 to 100.
Masonry Noncombustible %
Please enter a number from 0 to 100.
Fire Resistive %
Please enter a number from 0 to 100.
Other % (please describe)
Square footage
Number of stories
Please enter a number greater than or equal to 1.
Year built
Protections (ex: fire alarm, sprinklers, etc.)
Replacement Cost Value of Building (not market value)
Was this building owned or leased?
- Owned
- Leased
Occupancy/Type of Building (ex: Dwelling, Church, Hall, Kitchen, etc.)
If Occupancy/Type of Building is a school, please provide the following information.
Number of Students
Number of Teachers
Age Range
Date of last Valuation/Appraisal
Month
Day
Year
Is this location mortgaged?
- Yes
- No
If YES, bank's name
Bank's Address
Street Address Address Line 2 City State ZIP Code
Loan Number
Loan Amount
Additional Notes
CAPTCHA

Certificate of Insurance

I need to request a certificate of insurance. What should I do?

There are three ways you may acquire a certificate of insurance. You may request the certificate via fax (631) 424-3610, via email to our office or you may simply complete this online request form for processing within 1 business day.

Insured's Information
Insured's Name
Group Name (If Applicable)

If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.
Your Phone Number
Email Address*
Your Name
Insured's Address
Street Address Address Line 2 City State ZIP Code
Certificate Information
Please sekect one
- Property
- Auto Liability
- General Liability
- Worker's Comp
Limits being requested
Annual
Aggregated
Certificate Holder
Name
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Certificate Holder's Interests
- Certificate Holder Only
- Additional Insured
- Loss Payee
- Mortgagee
- Landlord
Loan Number
Loan Amount
Loan Location
Street Address Address Line 2 City State ZIP Code
Email Address
Reason for Certificate of Insurance
- Use of Facilities
- Internship
- Proof Only
- Leased Equipment
If leased equipment, please provide the following information:
Lease Number
Model Number
Value of Leased Equipment
Please provide event dates and description, if applicable
Additional Notes
CAPTCHA

What do I do if I have received a letter from my leasing company/bank asking for verification of insurance coverage?

There are two ways you can get this information. First, you may send the correspondence from the company or bank to our office or you may complete the online request form for processing within 1 business day.

What do I do if I received a letter from the DMV stating that they cannot verify insurance coverage?

There are two ways you can get the information you need to verify your insurance for the DMV. First, you may fax the correspondence from the DMV to us at (631) 424-3610 or if you prefer you may email it. A reinstatement notice will follow within 30 days from the DMV verifying coverage.

Student Accident Insurance Form

Basic Information
School
District

If part of a larger group, i.e. a Diocese, please name your sub-group, parish, etc.
Your Name
Email Address*
Your Phone Number
School's Address
Street Address Address Line 2 City State ZIP Code
If there is more than one location, please forward a list of additional locations.
Is this New Business or Renewal?
- New Business
- Renewal
Policy Number

If this is a Renewal, please provide your Policy Number.
If this is New Business, please provide your desired policy effective and expiration dates.
From
Month
Day
Year
To
Month
Day
Year
Estimated Enrollment
School Year
To
Number of Students and Teachers

*Only indicate the number of Teachers/Administrators if there is no Workers Compensation coverage and/or Accident Benefits desired for this category.
Grades Pre-K
Grades K-8
Grades 9-12
Adult Education
Number of Teachers/Administrators
Number of Interscholastic Football Players (Grades 10, 11, and 12)
Number of Tryouts
Number of Final Squad
Additional Notes
CAPTCHA

Camp Questionnaire

Basic Information
Your Name
Your Phone Number
Email Address*
Name of Camp
Camp Address
Street Address Address Line 2 City State ZIP Code
If there is more than one location, please include a list of additional locations.
Anticipate Camp Start Date
Month
Day
Year
Anticipate Camp End Date
Month
Day
Year
How many weeks will the Camp be in operation?
Estimated Number of Campers Per Week
Is the Camp a Day or Resident Camp?
- Day
- Resident
Is the Camp an Educational or Sports Camp?
- Educational
- Sports
Did the Camp have an accident insurance plan last season?
- Yes
- No
Please provide the name of the insurance company, a schedule of coverages, benefits and limits, and the premium and claims paid for the past three camp seasons. This additional information can be forwarded to our office by either fax or e-mail for the most prompt response, or by regular mail.
Sports Activities
If the camp involves sports, please list them here. Sport, Estimated Campers per Sport and Per week, Age range of Campers.
Additional Notes
CAPTCHA

Main: 631-423-9500
Toll Free: 800-275-9762

24 W Carver St, Huntington, NY 11743

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Toll Free: 800-275-9762

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CLIENT ACCESS

Customer Service

Forms

Claims - Auto, Property, Liability

How do I report a claim?

Select A Form

Insured's Information

Accident Information

Location of Accident

Your Vehicle

Other Vehicle

Additional Information

Loss Information

Claimant Information

Adding and Deleting Automobiles and Drivers

How do I add/delete a vehicle or a driver?

Select A Form

Insured's Information

Vehicle Deletion Information

Vehicle Addition Information

Replacement Vehicle/Addition Information

Registration Information

Leasing/Loan Information

New Driver Information

Driver Deletion

Adding and Deleting Properties

How can I add/delete or make amendments to a property?

Select A Form

Insured's Information

Addition Information

Deletion Information

If Occupancy/Type of Building is a school, please provide the following information.

Amending Limits and/or Contents of An Existing Building

Leasing/Loan Information

Building Information

Construction Type

If Occupancy/Type of Building is a school, please provide the following information.

Certificate of Insurance

I need to request a certificate of insurance. What should I do?

Insured's Information

Certificate Information

Limits being requested

Certificate Holder

What do I do if I have received a letter from my leasing company/bank asking for verification of insurance coverage?

What do I do if I received a letter from the DMV stating that they cannot verify insurance coverage?

Student Accident Insurance Form

Basic Information

If there is more than one location, please forward a list of additional locations.

If this is New Business, please provide your desired policy effective and expiration dates.

Estimated Enrollment

Number of Students and Teachers

Camp Questionnaire

Basic Information

If there is more than one location, please include a list of additional locations.