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Report an auto claim
Do you have a policy with TSC Direct??
Yes
No
Please Call 516-681-9400, Opt 5, 2
to file a Third-Party-Claim
Date of loss
Time of loss
AM/PM
AM
PM
Policyholder information
Full Name
Email
Address
Select your address
Primary phone
Secondary phone
Policy number
Alternate contact
Alternate contact
Yes
No
Full Name
Phone
Address
Select your address
Loss information
Type of loss
Incident Location Street/City/State/ Zip
Description of accident
Police of Fire Department contacted
Yes
No
Report Number
Insured vehicle
(Please input ‘NA’ where information is not currently available)
Vehicle make
Vehicle model
Vehicle year
Vehicle VIN
Plate number
Owner - Driver - Insured
Is vehicle's owner same as insured?
Yes
No
Owner's name
Owner's address
Is vehicle driver same as owner?
Yes
No
Driver's name
Driver's DOB
Driver's address
Select your address
Relationship to insured
Purpose of use
Drivers license number
Damage information
Description of damage
Where can vehicle be seen?
Was a standard child passenger restraint system (child seat) installed in the vehicle at the time of the accident?
Yes
No
Was the child passenger restraint system (child seat) in use by a child during the time of the accident?
Yes
No
Did the child passenger restraint system (child seat) sustain a loss at the time of the accident?
Yes
No
Other Vehicle/Property Damaged
(Please input ‘NA’ where information is not currently available)
Other vehicle damaged?
Yes
No
Vehicle make
Vehicle model
Vehicle year
Vehicle VIN
Carrier or Agency Name
Policy number
Owner's name
Owner's address
Select your address
Was the owner driving?
Yes
No
Driver's name
Driver's address
Select your address
Describe damage
Injuries
(Please input ‘NA’ where information is not currently available)
Any injuries
Witnesses or passengers
(Please input ‘NA’ where information is not currently available)
Any witnesses or passengers
Reported by
Name
Relationship
(if other than involved party)
Any person who knowingly and with intent to defraud any insurance company or other person files an application or commercial insurance or a statement of claim for any commercial or personal insurance benefits containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, and any person who, in connection with such application or claim, knowingly makes or knowingly assists, abets, solicits or conspires with another to make a false report of the theft, destruction, damage or conversion of any motor vehicle to a law enforcement agency, the department of motor vehicles or any insurance company, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the value of the subject motor vehicle or stated claim for each violation.
Fill out all fields with valid information
Submit claim