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Renters Property Loss Claim Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
E-Mail Address
Required
Policy Number
Required
Loss Overview
Loss Type
Required
What date did the incident take place?
Required
/ /
How severe was the damage?
Required
Describe the Loss
Required
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Segal Insurance Agency
424 Langley Rd
Newton, MA 02459

Ph: 617.527.4400
Fx:  617.964.8925
Segal Insurance Agency
968 Hancock St
Quincy, MA 02170

Ph: 617.773.7525
Fx:  617.328.7811
Segal Insurance Agency
Central Square Insurance

875 Massachusetts Ave., Suite 11
Cambridge, MA 02139

Ph: 617.876.1300
Fx: 617.441.8684
Deangelis Insurance
283 Merrimack St
Methuen, MA 01844

Ph: 978.682.3397
Fx:  978.681.0773
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