General Liability Claim Form Please fill out the general liability claim form below. Please enable JavaScript in your browser to complete this form.District Name *District Contact *FirstLastDistrict Address *District City *District State *District Zip Code *District CountryDistrict Phone Number *District Email Address *Date of Loss *Time of LossClaimant NameFirstLastClaimant AddressClaimant CityClaimant StateClaimant Zip CodeClaimant CountryClaimant Phone NumberClaimant Email AddressDescription of Incident *Police ReportCitationsOther CommentsSubmit *required fields