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 1-800-232-6992.

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Street:
City:
State:
Zip:
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Street:
City:
State:
Zip:
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Vehicle Year:
Vehicle Make:
Vehicle Model:
VIN (optional):
Driver's Name:
Driver's Address:
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1.
2.
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Name:
Address:
City:
State:
Zip:
Telephone Number:
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