Initiation of Loss Notification

Please complete and submit the required information below.

While receipt of the information by Washington Casualty Company does not constitute notification of a loss, it will allow us to promptly advise you of further steps to take.

Information that is bolded is required.

First Name: 

Last Name: 

Phone Number: 

When Can We Contact You? 

E-mail Address:

Policy Number:

Insured Name:

Insured Address:

City:

State:

Zip Code:

Date of Loss (mm/dd/yy): 

Brief Description of Loss: