Submit a Claim

To submit a claim to the Ohio FAIR Plan, please fill out the following form to the best of your ability. Please attach any pictures pertinent to the claim.

Claim Information

Your Name:	*
Relationship:	*
Phone:	--* Ext. Type:
Email:	*
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Policy Number:	enter numeric part only
Insured's Name:	*
Property Address:	*
City:	*
Zip Code:	-

	Primary Contact:

*	*
Phone:	--* Ext. Type: *
Phone:	-- Ext. Type:
Email:
Address:

	-
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	Additional Contacts:

	Add Additional Contact

Cause of Loss:	* Date of Loss: * Time:
Description of Loss:	*

Mortgagee:

Files

You have not attached any photos.

File Name

File Format

File Size

Use the fields below to attach a file. There is no limit to the number of files that you may add. However you may only add one file at a time.

Note: Files must be smaller than 10 megabytes and be in one of the following formats:

JPG, JPEG, GIF, TIF, BMP, PDF, PNG

Note that if you combine multiple photos into a PDF file, the total size of the PDF file must still be smaller than 10 megabytes.


	Click the "Browse" button to select a file, then click the "Attach File" link to attach the photo you selected to this claim.
File Location:
	Attach File

I have verified that the above information is correct to the best of my knowledge.

Processing your request...