Complete each part of the form below to send us your claim.
If you have any questions please call 800-394-2423 or email us directly @ claims@capitolinsurance.com

Part 1: Policyholder Information

Part 2: Accident Information

Part 3: Insured Vehicle Information

Part 4: Property Damaged (Not Insured Vehicle)

Part 5: Injured Persons

Enter the information for up to 4 injured persons. Should additional persons be needed, please advise your adjuster once you are contacted.

Injured Person 1

Injured Person 2

Injured Person 3

Injured Person 4

Part 6: Passengers

Enter the information for up to 4 passengers. Should additional passengers be needed, please advise your adjuster once you are contacted.

Passenger 1

Passenger 2

Passenger 3

Passenger 4

Part 7: Upload Photos

Please upload any photos of the vehicle damage, police reports or other related documents.

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