HomeMy Public PortalAboutInsurance FormTown of Watertown —149 Main Street Watertown, MA 02472
617-972-6486
Property Damage and Personal Injury Claim Form
Contact Information:
Full Name:
Street Address:
City/Town, State, Zip Code:
Phone/Email:
Date of Incident:
Authorities Contacted:
Full Description of the Incident:
Costs: $
Please submit all receipts, estimates and pictures of the event related to this claim.
The clerk's office submits the claim to:
MIIA Property & Casualty Group — 15 Cabot Road Woburn, MA 01801
Tel # 800-222-5963
The claimant will be contacted by MIIA Property & Casualty Group directly.