File A Claim – Alamance Farmers Mututal

Filing a claim online is fast and easy! It is important to file your claim as soon as possible to get the process started. Please fill out the form completely and accurately, and we will contact you as soon as possible.

Please, only file your claim one time. Submitting the same claim multiple times will slow down the processing time of your claim.

Contact Info
Policy Info
Loss Info
Misc. Info
Confirmation

Name

First Name

Last Name

Relation to Insured (Type 'Self' if you are the insured)

Agent Information

Agent Name

Agent Phone Number

Agent Email

Basic Information

Policy Number

Insured Name

Insured Phone Number

Insured Email

Best Time to Contact

Is there a mortgage on this property?

If Yes, Mortgagee Name

Policy Address

Street Address

Address Line 2

City

Postal Code

Loss Date/Time

Date of Loss

Time of Loss

Loss Details

Location of Loss (If different than the Policy Address)

Is It Safe To Remain In Your Home?

Reported to Police or Fire Department

Type of Loss

Describe The Loss

Outside Insurers

Other Insurance Covering the Property?

If Yes, Name of Insurance Company

Additional Comments

Certification

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 claim promptly if the report is being completed after hours or on weekends or holidays. Claims will be prioritized by severity, so that policyholders who are unable to live in their homes will be contacted first. This reporting capability is solely for the convenience of filing a claim .

I hereby certify that I have the authority to make this request by being the insured or a representative of the insured.

E-Signature (Full Name Required)

Contact Information

Policy Information

Loss Information

Miscellaneous Information

Confirmation

Name

First Name

Last Name

Relation to Insured (Type 'Self' if you are the insured)

Agent Information

Agent Name

Agent Phone Number

Agent Email

Basic Information

Policy Number

Insured Name

Insured Phone Number

Insured Email

Best Time to Contact

Is there a mortgage on this property?

If Yes, Mortgagee Name

Policy Address

Street Address

Address Line 2

City

Postal Code

Loss Date/Time

Date of Loss

Time of Loss

Loss Details

Location of Loss (If different than the Policy Address)

Is It Safe To Remain In Your Home?

Reported to Police or Fire Department

Type of Loss

Describe The Loss

Outside Insurers

Other Insurance Covering the Property?

If Yes, Name of Insurance Company

Additional Comments

Additional Comments

Certification

I hereby certify that I have the authority to make this request by being the insured or a representative of the insured.

E-Signature (Full Name Required)

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