Claims - KBSK Insurance

Describe the Incident

Incident Police Report Number and/or Case ID

Date

Time

City

State

ZIP code

Areas of Tractor/Trailer Damage

Support Pictures of Vehicles, Damages, etc

THIRD PARTY DRIVER DETAILS

Driver Name

Driver Date of Birth (DOB)

Driver CDL Number

Driver Contact Number

Driver CDL Picture

DAMAGE TRUCK INFORMATION

Truck Year

Truck Make

Truck VIN

DAMAGED TRAILER INFORMATION

Trailer Year

Truck Make

Truck VIN

CARGO DAMAGE

Commodity Name

Estimated Percent of Damage

THIRD PARTY DAMAGE DETAILS (CAR/TRUCK)

Year

Make

VIN

THIRD PARTY PROPERTY DAMAGE

Owner or Property Name

Owner Contact

THIRD PARTY INSURANCE COMPANY CLAIM

Insurance Company Name

Policy Number

Insurance Company Contact

Insurance company details of another party

Additional Attachments