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Filing a Claim

Please complete the report to the best of your ability. While not all areas need to be completed, the more information you can provide, the faster your claim can be handled. Once completed, click on the send button and the form will be emailed to Mobile Insurance.

We also encourage you to call us to discuss your claim (800)458-4320 during regular office hours. In the event of an after-hours emergency, feel free to call Mobile Insurance President Kurt Kelley's cell phone at (281)460-8384. If you can't reach someone immediately, leave a message and we'll call you back as soon as possible.

Policy Holder Information

Insured Name


Contact Person


Address




Telephone No.


Email Address


Date of Accident:


Location of Accident:


Describe the Accident:


Who was allegedly injured?
(include: name, address, telephone #)
(write "n/a" if no personal injury)

Describe the property that was damaged:
(write "n/a" if no property was damaged)


Describe the vehicles involved:
(note which vehicle is yours)
(write "n/a" if no vehicle involvement)


List the driver(s) of the vehicle(s):
(include: name, address, telephone #)
(write "n/a" if no vehicle involvement)


List the name, address and telephone number of all witnesses: