🚗 File a Collision Report

Complete the form below to submit your collision report. You will receive a confirmation with your report number by email.

1Fill the form

2Submit your report

3Receive your report number

4Agent contacts you in 24-48h

1. Policy & Reporter Information

POLICY NUMBER *

FULL NAME *

PHONE NUMBER *

EMAIL * Your report number will be sent here

2. Incident Details

DATE OF INCIDENT *

TIME OF INCIDENT

INCIDENT LOCATION *

TYPE OF DAMAGE *

INJURIES REPORTED?

Yes No

POLICE REPORT NUMBER * ⚠️ Without a police report number it is not possible to proceed with coverage.

3. Other Party Information

OTHER PARTY FULL NAME

OTHER PARTY PHONE

OTHER PARTY VEHICLE

OTHER PARTY DRIVER LICENSE

OTHER PARTY INSURANCE COMPANY

4. Incident Description

DETAILED DESCRIPTION *

5. Photos, Videos & Documents

ATTACH FILES * 📷 At least one photograph is required to process your claim.

Click or drag files here

JPG, PNG, MP4, PDF — Max 10MB each

By submitting this form, you certify that the information provided is accurate and complete. Your information is protected under CIENTINED INSURANCE's privacy policy.

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Report Submitted Successfully!

Your collision report has been received. Your report number is:

A confirmation has been sent to your email. A CIENTINED INSURANCE representative will contact you within 24–48 business hours.

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