FILE CLAIM

Complete the form below to report your insurance claim

Reporter Information

Tell us who is submitting this claim. If you provide an email, we'll send the confirmation there.

Reporter Full Name *

Reported By *

Reporter Email

Reporter Phone

Provide at least one way to contact the reporter: email or phone.

Loss Information

Date of Loss *

Time of Loss *

Location of Accident *

Description of Accident *

Authority Contacted

Report Number

Violations/Citations

Policyholder Information

Same as reporterCopies the reporter's full name, email, and phone when the reporter is the policyholder.

Tell us about the person named on the policy.

Policy Holder Full Name *

Policy Holder Email

Policy Holder Phone Number

Policy Number *

Mailing Address

Street Address

City

State

ZIP Code

Upload Damage Photos & Videos (Optional)

Upload photos of the damage to speed up your claim. The more documentation we have upfront, the faster we can process your payment.

Click to upload photos or videos

Photos, videos, PDFs, Word, Excel, and more

Additional details

All sections below are optional — adding more context helps us process your claim faster.

Optional: By checking this box, you agree to receive SMS/MMS text messages from Aguila Dorada General Agency, LLC about this claim, including claim updates, requests for photos or documents, secure upload links, and customer support. SMS/MMS consent is optional and is not required to submit a claim, buy insurance, receive claim handling, receive customer service, or complete any transaction. You may file or manage a claim without SMS/MMS by phone, email, web form, or other published channels. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for help, call 888.509.2342, or contact the claims team at claims@ad-ga.com. Mobile opt-in data and SMS/MMS consent are not sold or shared with third parties or affiliates for marketing or promotional purposes. See our Privacy Policy and SMS/MMS Terms.