If you need immediate assistance and would like to speak to a Customer Service Representative



Tuttle & Traina Insurance Agency, Inc.	Surety & Insurance Services Richard C. Traina William B. Tuttle Thomas D. Moylan Raoul Cormier
44 Main Street, Post Office Box 489, Sterling, MA 01564
Phone: (978) 422-7700 Fax: (978) 422-8106

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On-line Personal Auto Claim Reporting Form

If you need immediate assistance and would like to speak to a Customer Service Representative,
please call (978) 422-7709 or click the button below for

Online form

Contact Information

Last Name

First Name

Daytime Phone

E-Mail Address

Policy Holder Information

Policy Number

Policy Holder - Name

Policy Holder - Phone

Policy Holder - Address

Policy Holder - City

Policy Holder - State

Zip Code

Accident Information

Date of Accident

/ /

Time of Accident

AM PM

Accident Location - Address

Accident Location - City

Accident Location - State

Zip Code

Brief Description of the Accident:

Police/Fire Contacted

Yes No

Police/Fire Report Number

Police/Fire Department Name

Any Witnesses Present

Yes No

Did Injuries Result from Accident

Yes No

If "Yes" to above, please provide:
Name, Address, Phone Number, and Extent of Injuries of those Injured.

Damage Information

Was Policy Holder Vehicle Damaged

Yes No

If "Yes" to above, please provide the following:

Vehicle Year

Vehicle Make

Vehicle Model

Brief Description of Damage

Where can the Vehicle be seen

If other Vehicles Damaged please Describe

Please Describe Additional Property Damage

Fraud Warning
Any person who, with the intent to defraud or deceive, submits an application or files a statement of claim containing any false, incomplete or misleading information, or helps in any manner to commit a fraud against an insurer, may be subject to civil penalties and criminal prosecution for insurance fraud.

A Customer Service Representative will contact you.