NOTICE OF LOSS
Auto Claim
Please complete as many fields as possible.
CP Insurance Associates
Phone: 1-800-366-0036
Fax: 936-291-0069
Email: claims@cpiai.com
Claim Type:
Collision
Hit & Run
Hail
Stolen
Partial Theft
Fire
Flood/Water
Other:
Today's Date
MM
/
DD
/
YYYY
Loan No.:
Certificate No.:
1. Borrower(s):
3. Vehicle year, make, model, Vin#
Date of Loss:
MM
/
DD
/
YYYY
Multiple choice
Repo
Non-Repo
6. Location of Auto for Inspection:
Location Phone number
DETAILS OF OCCURRENCE:
Police/fire reports?
Case No:
Police Department:
Additional Information:
Lender Name:
Filed By:
Lender Address
Lender Phone
Lender Email
Please complete as many sections as possible and submit any supporting documentation.
CPIA CLAIMS
10/2019
SUBMIT FORM
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