Report a Claim

If you would like to report a claim to us directly, please contact us at 1-800-9-KOSMOS, or you are welcome to complete the form below and submit it to our office.

Your Name * Company Name * Phone Number * Email * Street Address

City

State

Zip

Insurance Company Policy Number Date and Time of Loss Location of Loss Kind of Loss Reported To (Fire Dept, Police Dept) Report Number Description of Loss Contact Person (who took your report) Contact Info (Phone or Email)