Type of Claim: Property Damage or Theft

Please fill in applicable fields (* denotes required field). Once completed, please click Submit Claim at the bottom of this form. A claims adjuster will contact you shortly.

For emergency claims requiring immediate attention occurring after hours (evenings, weekends or holidays) please contact a Cumberland Representative by telephone at 1-800-232-6992.

Policy Symbol (ex. HON):*
Policy Number (ex. 1234567):*
Policyholder Name:*
Name of Person Reporting Claim:*
Mailing Address:*
Street:
City:
State:
Zip:
Loss Location*
Street:
City:
State:
Zip:
Date of Occurrence:*
  MM DD YYYY
/ /
Primary Contact Name:*
Secondary Contact Name:
Primary Contact Telephone:*
Secondary Contact Telephone:
1.
2.
Description of Damages (What Happened?):*
Email Address:
Agent:
Name of Mortgage Company:
Did a Police or Fire Department respond?
If so, name of responding department:
Do you have a repair estimate:*
If yes, approximate $ amount of damages:
If available, please attach photographs depicting the loss:
Delaware Fraud Statement: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony.
Maryland Fraud Statement: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
New Jersey Fraud Statement: 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, is subject to criminal and or civil penalties.
Pennsylvania Fraud Statement: 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 subjects such person to criminal and civil penalties.
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