Requestor Contact information
If you are making this request on behalf of the policy holder, please enter your contact information below. If you are the policyholder, please enter your contact information.

SECURA Policyholder Contact Information
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Claims details

Where loss took place

NOTE: If you need to submit supporting files (images, documentation, etc), please reply to the confirmation email you receive after submitting this claims form and attach those assets to your reply, thank you.