Property and Liability

Report a Property, Liability, or Automobile Claim

To report a claim or incident online to MIIA Member Services, please complete the form below. The information you provide will be transmitted to our Member Services Staff and you will receive an acknowledgement via e-mail.

Property, Liability, or Automobile Loss Notice
*Member Community/District:
*Member contact person:
*Member contact e-mail address:
*Contact phone number (area code first):	--ext:
*Date of incident:
Description of Incident:
Please do not include sensitive subscriber information, such as Social Security Numbers in this form. This form can be viewed by a third party while in transit.
Location of incident:
Full name of person presenting claim:
Claimant phone number (area code first):	--ext:
Claimant address (line 1):
Address (line 2):
Claimant city:	State: Zip code:
Type of vehicle involved (if applicable):
Community/District department involved:
General comments:
Please do not include sensitive subscriber information, such as Social Security Numbers in this form. This form can be viewed by a third party while in transit.

*Items with an asterisk(*) are required fields.

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Page last revised: Thursday, February 7, 2008