Customer Services – Waldorf Risk Solutions

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.

Claims - Auto, Property, Liability

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(Required)

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

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

Authority Info

If YES, please provide the accident report number and any other relevant details.

Additional Notes

Loss Information

Date of Loss

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

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

Automobile - Adding and Deleting

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(Required)

Vehicle Deletion Information

Year

Make & Model

VIN Number

Termination Date

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

Registration Information

Addition Date

Delete & Replace Date

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

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

License Number

State of Issue

Termination Date

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

Additional Notes

Forms

How do I report a claim?

Claims - Auto, Property, Liability

Select A Form

Insured's Information

Accident Information

Location of Accident

Your Vehicle

Other Vehicle

Additional Information

Loss Information

Claimant Information

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

Automobile - Adding and Deleting

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

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

Property - Adding and Deleting

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.

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

Certificate of Insurance

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

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.