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Claim Reporter Contact Information

(please include area code)
(please include area code)
(please include area code)

Phenix Mutual Policyholder Information

(please include area code)
(please include area code)
(please include area code)
(Person we can contact regarding this claim)

Accident Information

mmddyyyy
(include city and state)


Policyholder Property Damages

Phenix Mutual Policyholder Vehicle Information

(Vehicle Identification Number)

Driver's Name, Address, Phone:

Policyholder Vehicle Damage


Other Party Property Damage(not the policyholder)

Additional Comments:

You must click this button and wait for the confirmation on your screen, otherwise your claim will not be transmitted.