Merrimac Lodi Mutual Insurance Company

File a Claim

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Today's Date

Date of Loss *

Agency

Was this reported to the police or authorities?

**ALL theft and vandalism claims must be reported to law officials.
**ALL claims involving death to livestock require a necropsy report, completed by a veterinarian.

Insured’s Contact Information:

Name/Insured *

Policy Number

Address *

City *

Zip / Post Code *

Primary Phone *

Best time to reach you at this number

Secondary Phone

Briefly describe the loss

Location of loss

Submitted to Company By

I hereby certify that I have the authority to make this request, by being the insured or a representative of the insured. *

File a Claim

Products

Bulletins

Find an Agent

Contact Us