Type of Claim: Automobile

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 856-451-4050.

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Policy Symbol (ex. HON):

Policy Number (ex. 1234567):

Policyholder Name:

Name of Person Reporting Claim:

Mailing Address:

Address Line 1

City

State

Zip Code

Loss Location:

Address Line 1

Address Line 2

City

State

Zip Code

Vehicle/Driver Information:

Vehicle Year:

Vehicle Make:

Vehicle Model:

VIN(optional):

Driver's Name:

Driver's Address:

Date of Occurrence:

Primary Contact Name:

Primary Contact Telephone:

Secondary Contact Name:

Secondary Contact Telephone:

Description of Damages (What Happened?):

Description of Damages:

Email Address:

Agent:

Name of Lender:

Did a Police or Fire Department respond?

If so, name of responding department:

Claimant Name

Claimant Address

Address Line 1

City

State

Zip Code

Do you have a repair estimate:

If yes, approximate $ amount of damages:

If available, please attach photographs depicting the loss:

Click or drag files to this area to upload. You can upload up to 5 files.

You may upload up to 5 images

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 files a statement of claim containing any false or misleading information is subject to criminal and 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.