Initial Claim Form— Please use the form below for non-emergency claim reporting only. After completing the form, use the Send button at the bottom to send the information to our Insurance Board Claims Staff. Or you may print out the form, complete it by hand, and fax it to (410) 788-1603. Date Reporting: Accident/Incident Date & Time: Church/Organization Name: UCCIB Church ID Number (if you know it): Street Address: P.O. Box: City: State: Zip:   Contact Person(s): Position: Daytime Phone: Evening Phone: Fax: E-mail: General Description of Incident: (We will contact you for additional information.) (Click on the Send Form button to submit this form.) Return to Claims Services Home • Who We Are • History & Mission • News & Updates • Services Coverages • Educational Resources • Stories from the Churches • Agents Staff • Forms • Links • Table of Contents • Contact Us • Search Agent's Area Insurance Board . 700 Prospect Avenue . Cleveland, OH 44115 (800) 437-8830 uccib@insuranceboard.org Copyright 2005-2007 Designed & Produced by