Germantown Mutual Insurance Company

Report a Claim

Claims Form

Please fill in the form below to submit a claim. Once you hit submit, you will be taken to a printable confirmation page. Please be sure to print this page for your records.

Insured Name
Address
City
State
Zip
Home Phone
Other Phone
Claimant Name
Address
City
State
Zip
Home Phone
Other Phone
Policy #
Agency Name
Type of Loss
Date of Loss
Details

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