Get Sedgwick General Liability Intake Form

Filling out the Sedgwick General Liability Intake Form can be straightforward if you follow the proper steps. This guide will walk you through the necessary fields and components to ensure your claims are reported accurately and effectively.

Follow the steps to complete your Sedgwick General Liability Intake Form successfully

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the client name, which is 'Delivery Service Providers', and the contract number, '6887'.
3. In the 'Insured Name' field, provide the name of the insured party along with the DSP Station Code where the vehicle operates.
4. Fill out the Reporter Information section, including the reporter's first and last name, title, email address, and phone number. Note that the first and last name fields are mandatory.
5. Next, provide Primary Office Information by supplying the street address, city, state, zip code, and phone number.
6. Input Insured Driver Information, including their first and last name, home phone, home address, city, and date of birth. The last name and phone number fields here are mandatory.
7. Fill out Insured Vehicle Information with details such as the VIN, body type, model, license plate number, year, make, and color.
8. Provide Incident Information by entering the date and time of the incident, along with the date the employer was notified. Describe the incident in detail, attaching a separate page if necessary.
9. In the Incident Location Information section, enter the street address, city, state, and zip code where the incident took place.
10. If applicable, fill out the Homeowner Information for the customer involved, including their first name, home phone number, and address.
11. In the Other Party Injury Information section, describe any injuries and indicate if the other party was transported by ambulance.
12. Complete the Damaged Property Information section by describing the property and the estimated damage.
13. If there are any witnesses, provide their name, address, city, state, zip code, and phone number.
14. Fill in your contact information at the end, ensuring to include your first and last name, phone number, and email address. The first name, last name, and phone fields are mandatory.
15. Once all sections are completed, save your changes, download, print, or share the form as required. Ensure to email the completed form to DeliveryServiceProviders@sedgwickcms.com.

Start completing your Sedgwick General Liability Intake Form online today to ensure the efficient processing of your claims.