Timber Creek Casualty Insurance Company Inc

First Report of Loss

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Please complete the form below detailing the incident, involved parties, and vehicle information.

Timber Creek Casualty Insurance, Inc.

A Risk Retention Group | 301 Louisiana Avenue, Bogalusa, LA 70427

Reported to: Robert

Claims Reporting Instructions

1. Immediate Notification: All claims must be reported immediately, but no later than twenty-four (24) hours after the loss.

2. Police Report: In the event of an accident involving injury or property damage, you must notify the police immediately and file an official report.

3. Documentation: Do not admit liability or fault at the scene. Gather all information (photos, witness names, other driver's insurance) and submit it via this form.

Incident Information

Witness Information

Witness 1

Witness 2

Claimant Information

Claimant 1

Claimant 2

Claimant 3

Claimant 4

Claimant 5

Claimant 6

Claimant Vehicle Information:

Was it towed: (Check to show details)

Timber Creek Insured Information

Timber Creek Insured Vehicle Information:

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Timber Creek Casualty Insurance, Inc.

Claims Reporting Instructions

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