Angler's Advantage

Anglers Advantage
Insurance Program
P.O. Box 795
Shawnee Mission, KS. 66201
Fax: 1-800-777-BOAT (2628)

Submit a Claim - Injury Claims

Old United Casualty Co.
P O Box 795
Shawnee Mission, KS 66201

Policy Information

Agency
Phone Number
Fax Number
Policy Number
Policy Term

Insured

Name Insured *
Additional Insured
Home Phone *
Work Phone
Cell Phone
Address
Address 2
City, State, Zip:
Fax Number
Email *

Loss Information

Date/Time of Loss *
Date/Time of Loss *
Type of Loss *
Operation Information
Description of incident
Extent of damage
Police/Fire Dept. reported to
Report Number
Boat location for inspection
Contact
Phone Number
Other party(ies) involved; Address/contact number
Other Insurance Address/phone #
Any Injuries?
1. YesNo
Description of Injury
Injured Party (Name/Address/Phone Number)

Insured Property

Vessel Yr. Manufacturer
Model Hin #

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