File A Claim Please provide the following information in as much detail as possible so that we can most effectively process your claim. Claim FormRelationship to Claim Policyholder Claimant Attorney Agent Public Adjuster OtherFirst Name Last Name Your AddressAddress Line 1 Address Line 2 City State Zip Code Home Phone Work Phone Extension Cell Phone Email Contact Information of Person Reporting the Loss Date of Loss Time of Loss Claim Type - Select -Building and ContentsEquipment BreakdownFireFloodHailInjuryLaw and OrdinanceLiabilityService LineTheft/Burglary/VandalismWindPolicyholder Name Policy # Loss LocationCounty City State Zip Code Briefly Describe what happened in the incident Were there any injuries? Yes NoInjured Party Information Your claim is ready to submit. Is there anything else that you would like to note. Submit File your claim by phone 1.855.CALL.KWS (225-5597) While your claim is being processed… Don’t admit responsibility for the accident or injury. Don’t give copies of documents to anyone other than company claims associates or authorized representatives.