Customers Submit a Claim

Submit a Claim

To submit a claim to the Ohio FAIR Plan, please fill out the following form to the best of your ability. Please attach any pictures pertinent to the claim.

Claim Information

Your Name *

Relationship *

Phone * -- Ext.

Type:

Send me text notifications

Email *

Policy Number

Enter numeric part only

Insured's Name *

Property Address *

City *

Zip Code *

Primary Contact

Same as Above

Contact Type *

Contact Name *

Phone * -- Ext.

Type: *

Send me text notifications

Alternate Phone -- Ext.

Type:

Address

City

State

Zip Code

Additional Contacts

+ Add Additional Contact

Cause of Loss *

Date of Loss *

Time

Mortgagee

Description of Loss *

Files

Use the fields below to attach a file. There is no limit to the number of files that you may add. However you may only add one file at a time.

Note: Files must be smaller than 10 megabytes and be in one of the following formats:

JPG, JPEG, GIF, TIF, BMP, PDF, PNG

Note that if you combine multiple photos into a PDF file, the total size of the PDF file must still be smaller than 10 megabytes.

Drag files here from your computer

Browse your computer

Click or drop here to add more

I have verified that the above information is correct to the best of my knowledge.

Processing your request...