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Report a Claim

You can either report a claim directly to us or to your insurance company. If you would like to report an automobile claim directly to us, please contact us at
 
Farquhar & Black Insurance Agency
85 Exchange Street
Lynn, MA 01901
Ph: 781.599.2200
 
Or simply fill in the form below and press the Submit button to submit information to receive a quote on auto insurance. We will be happy to get back to you soon. Your information will be submitted to our secure server. Your privacy is important to us. Please see our privacy policy for more information.
 
 
If you would like to report an automobile claim directly to the company, the following carriers have 24 hour direct claim reporting services available. Prior to calling, please have your policy number and claim details available for the claims adjuster.
 
Report a Travelers
Premier Automobile Claim
  
 
1-(800) 252-4684
Click here for reporting instructions
Report a
Business Automobile Claim
  
  
1-800-238-6225
Click here for reporting instructions
 
The insurance carrier will forward a copy of your claim report to our office. Also, if we can assist you in any way, please do not hesitate to contact us.
 


Back to Auto list

Auto Notice of Claim

Insured Information

Driver's Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Driver License Number/State  Number   State
Policy Owner's Name
Policy Number

Loss Details

Description of Accident. Include details of direction of travel for you and other vehicle and what you  were doing just prior to accident.
Description of other type of loss. (theft, vandalism, etc.)
Date of Loss  Time of Loss 
Location of Loss
Authority Contacted  Report Number 
Explain "Other Authority"
Were any citations issued?
If yes, what type

Your Vehicle

Year  Make   Model 
Veh. License
Number/State		  Vehicle ID Number 
Describe damage to your vehicle.
Where is your vehicle now?
Are you able to drive your vehicle?

Other Property or Vehicles Involved

 Describe Property damaged if other than another vehicle.
Vehicle 1
Year  Make   Model 
Veh. License
Number/State		  Vehicle ID Number 
Describe damage to your  vehicle.
Where is your vehicle now?
Are you able to drive your vehicle?
Owner's Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Driver License Number/State  Number   State
Policy Owner's Name
Policy Number
Vehicle 2
Year  Make   Model 
Veh. License
Number/State		  Vehicle ID Number 
Describe damage to your vehicle.
Where is your vehicle now?
Are you able to drive your vehicle?
Owner's Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Driver License Number/State  Number   State
Policy Owner's Name
Policy Number
Vehicle 3
Year  Make   Model 
Veh. License
Number/State		  Vehicle ID Number 
Describe damage to your vehicle.
Where is your vehicle now?
Are you able to drive your vehicle?
Owner's Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Driver License Number/State  Number   State
Policy Owner's Name
Policy Number

Injuries

1
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Describe Injury
2
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Describe Injury
3
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Describe Injury
4
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
Describe Injury

Witnesses

1
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
2
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
3
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
4
Name
Street Address
Street Address
City, State, Zip
Phone Number Home   Work 
 
  Security Code : 


Licensed in MA, ME, NH, and NY

info@FandBInsurance.com
85 Exchange Street • Lynn, MA 01901 • Ph. 781.599.2200


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