FMI Home Page
My Account
Agent Login
About
About FMI
Financial
Privacy
Careers
MENU
Home Insurance
Homeowner
Condo Owner
Renter
Landlord
Business Insurance
Business Owner
Workers Compensation
Nonprofit
Religious Institution
Claims
Resource Center
Contact
Locate an Agent
Identity Theft Claim
Explore
Home Insurance
Business Insurance
Claims
Contact Us
The Resource Center
Resources & Tips to Maximize Your Insurance
Start Learning
Locate an Agent
Identity Theft Claim
General Information
Policy Number
Date of Loss
Time of Loss
Date Claim Reported
04/13/2021
Insured / Policyholder Information
First Name
Last Name
Name of Business
Primary Contact Information
First Name of Primary Contact
Last Name of Primary Contact
Title / Relationship to Insured
Home / Primary Phone
Work Phone
Ext.
Cell Phone
Email Address
If none, leave blank.
Alternate Contact Information
First Name of Alternate Contact
Last Name of Alternate Contact
Title / Relationship to Insured
Home / Primary Phone
Work Phone
Ext.
Cell Phone
Email Address
Information Regarding Loss
Location of Loss
Type of Claim
Please make a selection
Identity Theft
Other
Severity of Claim
Please make a selection
Minor
Moderate
Severe
Brief Description of Claim:
Additional Information
First Name of Person Reporting Claim
Last Name of Person Reporting Claim
Title / Relationship to Insured
Enter your email address here
if you would like to receive an electronic confirmation that this claim has been successfully submitted.
Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.
ERROR
×