Claims Intake First Notice of Loss

First Notice of Loss

¡Tell us what happened.!

We're here to help. The more complete your information, like names, phone numbers and full addresses, the faster we can review your claim and the fewer follow-up calls you'll need. Fields marked with * are required. If you don't know something, leave it blank.

01About you

The person filling out this form. (You don't have to be the insured driver.)

Full name *

Relationship to the SNAP insured *

Phone number of contact *

Email *

Who do you represent? *

Name of passenger *

Which vehicle was the passenger in? *

Insured vehicle Claimant vehicle Unknown

Name of the firm *

Address of the firm

Street address *

e.g. 409 E Campbell Rd

Suite or floor optional

City *

State *

ZIP code *

You represent the claimant. Your company's name, phone, address, policy number and claim number go in section 13, "Claimant insurance".

How are you related to the claim? *

02SNAP policyholder

If you don't have the SNAP policy number, we'll need the VIN or the insured's driver's license to find it.

SNAP policy number the numbers on their own are enough

Policyholder name *

I don't have the policy number

No policy number? No problem - please provide the VIN or the insured's driver's license below so we can locate the policy.

SNAP Insured vehicle VIN 17 characters

SNAP Insured's driver's license #

Driver's license state

03When & where

The basic facts of the accident.

Date of accident *

Time of accident *

Where did it happen?

Address or nearest intersection *

City *

State *

ZIP code *

Type of incident *

In your own words, describe what happened *

04Police

Were officers called to the scene?

Were police notified? *

Yes No

Police department / Agency

Police report number

Were any citations issued?

Yes No Don't know

Citation details

Who was cited?

Citation / Ticket number

Violation / Charge e.g. failure to yield, following too closely

Additional notes optional

The SNAP policyholder's side

The vehicle, driver and passengers covered by the SNAP policy.

05The SNAP insured vehicle

The vehicle covered by the SNAP policy, involved in the accident.

Year

Make

Model *

Color *

License plate

Plate state

VIN 17 characters

Was the vehicle damaged? *

Yes No

Type of damage *

Damage to the vehicle *

Impact zone reference

Use the diagram to help describe the damage on the vehicle.

Was the vehicle drivable? *

Yes No

Was it towed? *

Yes No Unknown

Tow facility name

Tow facility phone number

Tow facility address

Street address

e.g. 409 E Campbell Rd

Apt, suite or unit optional

City

State

ZIP code

06SNAP Vehicle ownership

Is the insured driver also the registered owner?

Is the insured driver the owner of the vehicle? *

Yes - same person No - different person Unknown

Owner's full name

Owner's phone

Owner's date of birth

Owner's address

Street address

e.g. 409 E Campbell Rd

Apt, suite or unit optional

City

State

ZIP code

07SNAP Insured driver - personal info

The person who was driving the insured vehicle.

Full name *

Date of birth

Phone

Email

Driver's license #

License state

Current address

Street address

e.g. 409 E Campbell Rd

Apt, suite or unit optional

City

State

ZIP code

08SNAP Insured driver injury

Was the SNAP insured driver injured? *

No Yes Unknown

Describe the injuries *

Treatment status *

Treatment type *

09SNAP Insured vehicle passengers

Anyone else in the SNAP insured vehicle at the time of the accident.

Were there any passengers? *

No passengers Yes - add details

Claimant

The claimant vehicle, its driver and passengers. Not insured by SNAP.

11Claimant driver - personal info

The person who was driving the claimant vehicle.

Full name

Date of birth

Phone

Driver's license #

Address

Street address

e.g. 409 E Campbell Rd

Apt, suite or unit optional

City

State

ZIP code

12Claimant driver injury

Was the claimant driver injured?

No Yes Unknown

Describe the injuries *

Treatment status *

Treatment type *

13Claimant insurance

The company that insures the claimant vehicle, if you know it.

Insurance company name

Insurance company phone

Insurance company address

Street address

e.g. 409 E Campbell Rd

Apt, suite or unit optional

City

State

ZIP code

Policy number

Claim number if already opened

14Claimant vehicle passengers

Were there passengers in the claimant vehicle? *

No Yes - add details Don't know

15Property damage (other than vehicles)

Fences, mailboxes, bikes, signs - anything that wasn't a vehicle.

Was any non-vehicle property damaged (fence, mailbox, utility pole, bike, etc.)? *

No Yes

16Witnesses

Anyone who saw what happened. Passengers are not considered witnesses - please add them under the passengers sections (09 and 14) instead.

Were there any witnesses? *

No Yes - add details

17Add photos of the damage and supporting evidence

Adding photos helps us move faster. Include the damage, anything taken at the scene, the police report, and the claimant's insurance card if you have them. They're sent right along with your report.

You can take new photos or pick from your gallery. Tap "Add photos" again for each new photo - they'll keep adding to the list below and are optimized automatically before sending.

Please include each of these views. Tap Add photos above when you're ready.

Front View

Rear View

Passenger Side

Driver Side

Also include these 3 photos:

VIN Number

Odometer

Interior

18Submit your report

Sign and send. We'll be in touch within 24-48 business hours.

Type your full name to sign *

Date defaults to today - change if needed

I attest that the information I have provided is true and complete to the best of my knowledge. I understand this notice will be reviewed by Snap Insurance's claims team and that providing false information may affect my claim.

Sent to claims@snapmga.com