Home About Us Products FAQ Request Information Agent Login HOME FILE A CLAIM FILE A CLAIM POLICYHOLDERS may complete and submit the Claim Form below. Insured Name* Policy Number* Email* Phone Contact Name* Contact Address* Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands (US) Virginia Washington West Virginia Wisconsin Wyoming Armed Forces (the) Americas Armed Forces Europe Armed Forces Pacific Army Post Office (U.S. Army and U.S. Air Force) Fleet Post Office (U.S. Navy and U.S. Marine Corps) State ZIP Code Date & Time of Loss (MM/DD/YYYY HH:MM)* Loss Location* Type of Loss Fire Lightning Wind Water Hail Theft Smoke Vandalism Other Is property habitable at this time?* Yes No Describe Loss 5000/5000 Estimated amount of loss?* Other insurance covering this property?* Yes No Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.* AGREE By checking the "Agree" button, you acknowledge that you have read and understand this MANDATORY FRAUD STATEMENT. Disclaimer: This claim will be reviewed and contact will be made as soon as possible on the next regular business day following receipt of this notice. We may not receive this promptly if the report is being completed after office hours or on weekends. This reporting capability is solely for the convenience of filing a claim after hours or when it is not feasible to contact your agent during normal business hours.* I hereby certify that I have the authority to make this request by being the insured or a representative of the insured. PRODUCTS FAQ FILE A CLAIM MAKE A PAYMENT CHECK BALANCE BECOME AN AGENT Are you a licensed Agent in New York State? Interested in representing Ontario Insurance Company and offering your clients additional insurance options? Send us your contact information and we will help you get onboard our network of agents. BECOME AN AGENT Home About Us Products FAQ Request Information Privacy Policy File A Claim Make A Payment Become An Agent 28 Canandaigua Street Shortsville, NY 14548-9762 Phone: 585-289-9560 Fax: 585-289-6826 © 2018 Ontario Insurance Company Insurance Website Design by ACS