Agribusiness Solutions Claim Form

General Liability, Property and Business Auto

You can use this online form to report losses for your Agribusiness Solutions policies, including General Liability, Property, and Business Auto.

Please make sure that you have an Agribusiness Solutions policy with Zenith by checking your policy number. It should start with 3 letters (e.g., CFP 12345678).
Please Enter Zenith Agribusiness Solutions Policy Number: *
Policyholder Information:

Are you the best person to contact during the claim process? If you select "No," you will be prompted to enter alternate contact information. *


Contact Information:

Please select the type of claim:

General Liability

New Claim Information:
Bodily Injury/Property Damage Information:
Witness

Property Loss

New Claim Information:

What kind of property loss was this? *

Business Auto

New Claim Information

Policyholder Vehicle:

Driver Information

Is the driver information the same as the policyholder information filled out above? *

Was anyone injured in this vehicle? *

Injured Person #1
Injured Person #2
Injured Person #3
Injured Person #4
Passenger #1:
Passenger #2:
Passenger #3:

Other Vehicle Damaged:

Other Vehicle Owner Information

Was the driver of the other vehicle also the owner listed above? *


Other Driver Information
Injured Person #1
Injured Person #2
Injured Person #3
Injured Person #4

Passenger #1:
Passenger #2:
Passenger #3:


 
 
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