Auto Incident

Template for Drivers

Insured Detail
Accident Detail
Was vehicle parked and unattended?
Reported to Police?
Citation Issued?
Other Party Detail
Injured Detail
Check one:
Taken by Ambulance?

If submitted properly, a confirmation email will be sent to you.

If there are any questions, please contact your P/C Claim Representative at pcclaims(at) or 800-292-5421.