Rowing Claim Form | Leonard Insurance Group

Name of Insured*
First Last
How you are listed on your paperwork.
Date of Loss*
Last 5 digits of policy number
These should be after the dash.
Location of Loss
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name Body of Water if loss happened there
Name of person filing out this report
First Last
Phone
Email
Equipment involved in loss
Description of what happened
Was someone else at fault?
- Yes
- No
Name
First Last
Phone
Repair Facility you intend to use
Estimate of loss in dollars, if known
Upload Pictures
Drop files here or

Accepted file types: jpg, gif, png, pdf.
Who should receive the insurance proceeds?
- The insured
- The repair facility
In the event of a total loss there can be salvage so please indicate if you think that applies.
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