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Claim Submission
GMI Claims
All Other Claims
GMI Policy Number *
GMI Insured Name *
GMI Insured Phone
GMI Insured Email
GMI Driver Name *
GMI Insured Vehicle (make, model, year) *
GMI Insured Vehicle VIN
GMI Insured Vehicle License Plate
Claimant Name *
Claimant Driver Name *
Claimant Phone
Claimant Email
Claimant Vehicle (make, model, year) *
Claimant Vehicle Passenger Name (if applicable)
Claimant Attorney (if applicable)
Claimant Adjuster (if applicable)
Claim Number (if applicable)
Detailed Incident Description *
Incident Date *
Incident Time
Incident Location *
Police Report Filed *
Yes
No
Injury to Insured Driver and/or Passenger *
Yes
No
Description of Injuries sustained by Insured Driver/Passenger *
Injury to Claimant Driver and/or Passenger *
Yes
No
Description of Injuries Sustained by Claimant Driver/Passenger *
Photos of Damage to Insured Vehicle
Photos of Damage to Claimant Vehicle
Video of the Incident
Police Report (if available) *
Other
Your Relationship to the Insured *
Insured
Claimant
Broker/Agent
Claimant Attorney
Claimant Carrier
Other
Your Name *
Your Phone *
Your Email *
Leave this field empty
Submit form
Policy Number *
Insured Name *
Insured Phone
Insured Email
Claimant Name *
Claimant Phone
Claimant Email
Claimant Attorney (if applicable)
Detailed Incident Description *
Incident Date *
Incident Time
Incident Location *
Police Report Filed *
Yes
No
Description of Injuries Sustained by Claimant *
Photos of the Incident/Injuries
Video of the Incident
Police Report (if available)
Other *
Your Relationship to the Insured *
Insured
Claimant
Broker/Agent
Claimant Attorney
Claimant Carrier
Other
Your Name *
Your Phone *
Your Email *
Leave this field empty
Submit form