Automobile Loss Notice

Use this form to report property loss. Please note that completing this form is not the equivalent of contacting the Insurance Company which is a requirement as expressed in your contract of insurance. This form is only a tool to help speed up the claim process.

(*) indicates required fields.

Step 1 - Insured Information

* Policy Number:

* Name And Address:

* Email:

* Phone:

Business Phone:

Fax:

Step 2 - Contact Information

* Name And Address:

* Email:

Phone:

Business Phone:

Fax:

Step 3 - Loss Information

Location Of Accident:

Authority Contacted:

Report Number:

Description Of Accident:

Step 4 - Lewis Insured Vehicle

Owner

Driver

Check if the driver is the same as owner:

Drivers Name And Address:

Relation To Insured:

Date Of Birth:

Drivers License Number:

Drivers License State:

Purpose Of Use:

Used With Permission: Yes No

Vehicle

Year:

Make:

Model:

VIN - Vehicle Identification Number:

License Plate Number:

License Plate State:

Body Type:

Damage

Describe Damage:

Estimate Amount:

WHERE Can Vehicle Be Seen?:

WHEN Can Vehicle Be Seen?:

Step 5 - Other Vehicle/Property

Other Owner

Other Vehicle/Property Insured: Yes No

Company Or Agency Name:

Policy Number:

Name And Address:

Phone:

Business Phone:

Other Driver

Check if the driver is the same as owner.

Name And Address:

Phone:

Business Phone:

Damage

Property Damaged: (if auto include: year, make, model, plate#)

Propable Estimate Amount:

Property Damage Seen:

Injured

Name & Address

Phone: (A/C, No)

Extent of Injury

Witnesses or Passengers

Name & Address

Phone: (A/C, No)

Remarks:

Reporter & Adjuster

Reported By:

Adjuster Reported To:

Bank Information

Bank Name And Address:

Account Number:

ABA Routing Number:

Filling out this form is not the equivalent of contacting the Insurance Company which is a requirement as expressed in your contract of insurance. This form is only a tool to help speed up the claim process.

If you have any questions, please call us at the numbers listed below.

Lewis Mexican Insurance

A low limit of Auto Liability puts you and your family at risk

Superb Mexican Tourist Auto Insurance that includes $500,000 CSL USD Liability for Bodily Injury and Property Damage!

It is critical to have enough liability coverage in Mexico now that Mexican laws can result in judgements that are closer in severity to that of the U.S.A. and Canada.

Simply Great

Simply Great Mexican Auto Insurance Coverage, underwritten by Qualitas Compania de Seguros, S.A. de C.V., the company that insures more vehicles in Mexico than any other! Represented by Lewis and Lewis Insurance Agency, the Qualitas Agent and Broker of Mexican Insurance that insures more Tourist Vehicles with Qualitas than any other.

Great Prices

Our Mexican Tourist Auto Liability prices are among the lowest you'll find for such great Coverage!

10 day rates start at $73.35 USD
30 day rates start at $97.10 USD
90 day rates start at $111.05 USD
6 month rates start at $129.19 USD
Annual rates start at $154.69 USD

Get a Mexican Insurance Quote now!

Traveling to Mexico

U.S. Department of State
All U.S. citizens traveling outside of the United States by land are required to present a WHTI compliant document to return to the United States. For more official information regarding travel to Mexico, visit the U.S. Department of State's website at Travel.State.Gov

Entry Requirements
Mexican Auto Insurance is required in all of Baja California. For the latest entry requirements, visit the Embassy of Mexico's website or contact the Embassy of Mexico at 1911 Pennsylvania Avenue NW, Washington, DC 20006, telephone (202) 736-1600, or any Mexican consulate in the United States.

Helpful Mexican Insurance Links
Essential information you should know before traveling to, and from Mexico:

Additional information about Mexican Insurance and Mexico can be found here...