• If you need to report a claim, the form below will get the pertinent information to us quickly and efficiently. The Loudoun Mutual main office or the agent servicing your policy will be in touch with you. if you would prefer to give this information over the phone, please contact us at 1-800-752-3458.

    An asterisk (*) indicates a required field.


  • Policy Number (if known)
  • Date of Loss


  • Name and Address of Person Submitting this Request

  • Name**
  • Address**
  • City**
  • State**
  • Zip**
  • Phone Number**


  • Policyholder's Information (if different than above)
  • Name
  • Address
  • City
  • State
  • Zip
  • Phone Number


  • Brief Description of Loss**
  • List of Items Damaged/Lost**
  • Policyholder's Email Address

  • * Mandatory fields.

    Click Submit to send your information to Loudoun Mutual.