To submit this form, first ensure that all required fields are accurately completed. Attach any necessary documentation supporting your claim. You may submit the form via email to claims@hanover.com, fax it to the number provided on your policy documents, or file it online through Hanover Insurance Group’s claim submission portal. Alternatively, you can mail the completed application to Hanover Insurance Group, Claims Department, [Insert Address Here]. It’s advisable to keep a copy of the submitted form and any related correspondence for your records.

There are no specific dates mentioned for this form for 2024 and 2025. Please refer to your policy documents or contact Hanover Insurance Group for any deadlines related to claims submission.

The purpose of this form is to provide Hanover Insurance Group with detailed information about a claim, suit, or circumstance that might lead to a claim. By thoroughly completing this supplemental application, applicants ensure that the insurer has all the necessary information to process and evaluate the claim accurately. This form helps in documenting the specifics of the claim, detailing involved parties, reporting status, and outlining any actions taken in response to the incident. By filling out this form, applicants facilitate a smoother and more efficient claims handling process. This form is a crucial document for insured parties when reporting incidents that could give rise to a claim. Proper completion and submission of the form ensure compliance with policy requirements and aid in the effective management of claims.

• 1. General Information: Includes fields for the applicant’s name, address, primary contact, and other basic information.
• 2. Claim Information: Requests specifics about the claim, such as involved individuals, dates, locations, and current status.
• 3. Declarations: The applicant must declare that all information provided is accurate and complete to the best of their knowledge.
• 4. Material Change: Requires the applicant to report any significant changes in the condition or information between application and policy inception.
• 5. Notice Sections: Includes various state-specific notices about the legal implications of providing false information.

Failing to submit this form can result in delays or denial of your insurance claim. It's crucial to complete and submit it accurately to facilitate the claims process.

• Claim Denial: Incomplete or missing form submission could lead to the denial of your insurance claim.
• Coverage Issues: Not reporting claims properly can result in issues with your policy coverage and limit the insurer's ability to provide assistance.
• Legal Consequences: Failing to declare changes or provide false information can have legal repercussions and affect your standing with the insurer.

• 1. After an Incident: Submit the form following any incident that could potentially lead to a claim.
• 2. During Claim Reporting: Complete this form when formally reporting a claim to your insurer.
• 3. For Record Keeping: Use this form to document and keep records of any claims or incidents related to your insurance policy.
• 4. Policy Updates: Fill out the form when submitting information about changes that might affect your policy to the insurer.
• 5. Legal Purposes: Ensure the form is completed accurately for any legal proceedings or documentation related to insurance claims.