Submit a Claim to BancInsure

Step 1: Please complete the information in the form below and click Submit.

Step 2: You may be required to provide additional support documents based on the type of claim you are submitting.

Property, general liability or automobile claims require a completed Acord Loss Notice. Workers compensation claims require a completed state specific First Notice of Injury.

Send these items, along with any other support documents such as invoices, pictures, letters, etc., as a file attachment to biclaims@bancinsure.com.

Today's Date:
*Agent's Name:
*Insured's Name:
*City / State / Zip:
*Phone:
Fax:
*E-mail:
*Contact Person:
*Claimant's Name:
*Date of Loss/Injury
*Policy Number:
Brief Description:
	* Required Field