Lewis & Lewis Mexican Auto Insurance

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

Step 2 - Contact Information

Step 3 - Loss Information

Step 4 - Lewis Insured Vehicle

Owner

Driver

Vehicle

Damage

Step 5 - Other Vehicle/Property

Other Owner

Other Driver

Damage

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

Injured

Witnesses or Passengers

Reporter & Adjuster

Bank Information

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.

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