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Submit a Claim

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Please fill out all the necessary information below.

If you do not know the information, please put N/A.

Policyholder Name

Policyholder Phone and Email Address

Claim Number

Policyholder Details

Loss Date | Type of Loss

Loss Address

ALE Limit | ALE Spend

Daily Food Expenditure

Approved Receipt Collection Period

Is alcohol approved or limited per meal?

Are groceries approved? Which items?

Are unitemized receipts or bank statements approved?

What is the radius for approved receipts?

This receipt collection one-time or ongoing?

Adjuster Name, Phone, and Email Address

Additional Information

Thanks for submitting your claim!

We'll be in touch as soon as possible.

hello@teamoope.com

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