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ClaimsF

Online Property Claim Form

REPORT A PROPERTY CLAIM
UMIALIK INSURANCE COMPANY
a member of the
WESTERN NATIONAL INSURANCE GROUP
*   Denotes required fields.
Umialik Policyholder Information
Type of Policy  
Policy Number   
Umialik Policyholder's Name  
Address  
City 
State 
Zip 
Contact Name 
Contact Phone 
Person Submitting Claim is:
E-mail of Person Submitting Claim:   
Other Party Information
Name of Other Party 
Address 
City 
State 
Zip 
Contact 
Contact Phone 
Loss Information
Date of Loss  
Loss Location  
Location of Damaged Property  
Description of Accident or Loss
Injury Information
Was anyone injured?  
No Yes
If yes, how many?  
Name of
Injured Party(s)
Description of
Injury
Telephone
Number








If more than 4 injuries, please list below  
Please enter the words you see in the box, in order and separated by a space. If you are unsure what the words are, click the reload button next to the distorted words.