Please complete the form below. If any of the required information (indicated by an * ) is not available, please type UNKNOWN except for required telephone numbers and zipcode. Click on the Report Claim button to start processing your claim. If you have any question(s), call  us at  1-800-393-LOSS. Company Seminole Casualty Insurance Company Reporting Person  Name Telephone# Best time to call * * Email * * Report by Insured Claimant Attorney * Seminole's Insured Information Home phone# Policy# Work phone# Cell phone# Name Address City State FL Zip Code Email * * * * * * * * * * At least one phone# required * Loss Information Loss Date Police Report Case No. Authority contacted Violations/Citations Accident location Loss Time: AM/PM * * * * * * * Accident Description * Seminole's Driver Information Driver's Name Home Phone# Work Phone# Address Relation to insured D.O.B Driver License# * * * * * Seminole's Insured Vehicle VIN# Year Make Model Tag# Vehicle Location Describe Damage Tow Company Phone# * * * * * * Color Y N Is vehicle drivable? Was vehicle towed? Y N Claimant #1 Information Note: This section refers to the information of the person you had the accident with. Owner Address Home phone Work phone Driver Name Address Best time to call * * Home phone * Work phone * * * * Property Description * Vehicle Location * Describe damage * Ins. company VIN# Year Model Policy# Tag# Make Property Damage Y N Is vehicle drivable? Color Claimant #2 Information Note: This section refers to the information of the person you had the accident with. Owner Address Home phone Work phone Driver Name Address Best time to call * * Home phone * Work phone * * * * Property Description * Vehicle Location * Describe damage * Ins. company VIN# Year Model Policy# Tag# Make Property Damage Y N Is vehicle drivable? Color Claimant #3 Information Note: This section refers to the information of the person you had the accident with. Owner Address Home phone Work phone Driver Name Address Best time to call * * Home phone * Work phone * * * * Property Description * Vehicle Location * Describe damage * Ins. company VIN# Year Model Policy# Tag# Make Property Damage Y N Is vehicle drivable? Color Injured Phone# Cell# Age Vehicle Name/Address Insured Vehicle Pedestriam Claimant1 Claimant2 Claimant3 Insured Vehicle Pedestriam Claimant1 Claimant2 Claimant3 Insured Vehicle Pedestriam Claimant1 Claimant2 Claimant3 Extent of injury * *