Please complete the form below. In case required information (indicated by an *) is not available,  you can type in UNKNOWN, NONE or DON'T KNOW. Click on the Report Claim button to start processing your claim. If you have any question(s), call  us at 1-877-476-NISP (6477). Company NATIONAL INSURANCE SERVICE PLAN Reporting Person  Name Telephone Best time to call * * EMail * * Insured Information Home phone Policy No. Work phone Cell phone Name Address City State FL Zipcode EMail * * * * * * * * * * At least one phone# required Loss Information Loss Date Case# Authority contacted Violations/Citations Accident location Loss Time * * * * * Accident Description * Insured Vehicle VIN# Year Make Model Tag Driver Name Home Ph Work Ph Address Relation to insured D.O.B Driver License# Is vehicle drivable? Vehicle Location Desc damage Was Vehicle towed? Tow company Phone * * * * * * * * * * * Claimant Information Owner Address Home phone Work phone Driver Name Address Best time to call * * Home phone * Work phone * * * * Property Damage Property Description Is vehicle drivable? Vehicle Location Desc damage Ins. company Policy# VIN# Year Make Model Tag * * * Injured Phone# Cell Phone#   Age Veh Ped Name and Address     Ins Oth Ins Oth Ins Oth Extent of injury * * * * * * Witness or Passenger Phone# Cell Phone# Veh Name and Address Ins Oth Ins Oth Other(specify) Wit Pas Type Wit Pas * * * * Remarks Please, correct the following error(s): Reporting person's name is required Reporting person's telephone is required Insured name is required Insured address is required Insured city is required Insured zipcode is required At least one Insured phone# is required Case # is required Loss Date is required Authority contact is required Accident Location is required Accident Description is required Vehicle's VIN# is required Vehicle's Make is required Vehicle's Year is required Vehicle's Model is required Vehicle's Driver name is required Vehicle's driver address is required Vehicle's location is required Claimant owner is required Claimant Address is required Claimant Driver Name is required Property description is required Vehicle Location is required Damage description is required