Martin Claims Service Online Claims Assignment Form

Claim Form by Email

Fill out this form and click on SUBMIT BUTTON at the bottom of the page.

ATTENTION: Martin Claims Service, Inc.

Check all appropriate processing for this claim assignment:
Full assignment
Photos required
Appraise collision
Appraise property damage
Secure official reports
Scene Investigation
Secure recorded statements
Evaluate bodily injury/business interruption
Cause & origin investigation
Obtain expert
Ins. to value worksheet

Company Assigning Claim
Name (required):

Email (required):

Company Assigning Claim:

Phone Number:

Claim Number:



Policy Number:

Date of Loss:

Insured's Address:

Insured's Telephone:

Claimant's Name and Address:

Claimant's Telephone:

Loss Location:        Closest N.C. city -- >       
          OR SELECT         N.C. county --->       
Loss Location (more detail if necessary):

Local Authorities (police, fire department, etc.):

Description of Loss:

Handling Instructions: