Make a Claim - Cayuga Mutual - Insurance Company

Make a Claim

If you require immediate assistance please call 1-800-567-3381. Otherwise complete the following form and a Cayuga claims representative will contact you within one business day. If you need after hours or weekend claims assistance please call 1-888-346-6610.

Personal Information

Your details

* Name of Policyholder/Insured
* Street No. and Name	Apt No.
* City	* Province
* Country	* Postal Code
* Home Phone	* Cell Phone
Work Phone
* Best Number to be reached at	* Email Address

Insurance Information

Contact details

Policy Number	Agent
* What type of loss have you experienced?
* Location of the Loss
* Details Regarding the Loss
Other Remarks

Auto Claim Information

Auto details

* Is the driver the Policy Holder? Yes No	* Drivers Relation to Insured
* Drivers' Name	* Street No and Name
Apt No.	* City
* Country	Province/State
Postal Code/Zip Code	Driver's License Number

* Vehicle Make	* Vehicle Model
* Vehicle Year	VIN Number
* Is the vehicle drivable? Yes No
* Location of the Vehicle now
* How many passengers (excluding driver)	* Were there any injuries? Yes No
If yes, Names of injured
Nature of injuries
Age of injured	Phone Number
* Were other vehicles involved in the accident? Yes No	Name of driver
Insurance Company
Vehicle Make	Vehicle Model
Vehicle Model Year	Drivers License Number
Were there any injuries? Yes No
Location of the vehicle now
Other Remarks