BAA USA Claim Form Brotherhood Auto Aid USA Claim Form Section A - Policyholder Information Name * Email Telephone * Mobile Fax Address * City * State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip * Date of Loss * Name of Driver * Age * Was the driver properly licensed? * Yes No Section B - Vehicle Information Policy Number * Year * Make * Model * Trim VIN (17 characters) * Is there a lien against this vehicle? * Yes No Miles * Name of Lien Holder Section C - Comprehensive Claim *If you choose a Section C item, please fill out Section D - How did the incident happen? Glass Glass Flood Fire Fire Hail Theft Theft Storm Hit & Run Hit & Run Vandalism Animal Collision Animal Collision Projectile Section D - Collision Claim Was this a single vehicle or a multi-vehicle incident? * Single Multiple How did the accident happen? * Need more room? Upload Document Drop a file here or click to upload Choose File Maximum file size: 15MB Who was at fault in this accident? * You Other Party Was the incident reported to the authorities? * Yes No Is your liability company responsible for damage to the other party's vehicle? * Yes No Please provide the Name, Address, and Age of the other party involved. * Have you tried to obtain payment from the other party's liability? * Yes No Please Explain * To what extent? Section E - Claim amounts When there is a loss, you shall provide BAA with an estimate from a reliable body shop as to the repair work needed. Only one estimate is required if: (1) the body shop is owned by a member of the Church of God in Christ, Mennonite, or (2) the loss amount is less than $5,000.00, or (3) the vehicle is legally or mechanically not drivable, or (4) it is for a glass loss. If damage exceeds $5,000.00, only one estimate is required if the body shop obtains approval for their estimate from the BAA office before repairs with direct payment issued to said body shop. If two estimates are filed, BAA will make settlement according to the lowest estimate received. BAA will pay the lowest bid per rules and regulations. Checks will be issued to the policyholder unless other arrangements have been made. Non-Licensed drivers on public roads are not eligible for BAA Coverage. Please list estimate amounts. Estimate 1 $ Estimate 2 $ Please list salvage bids if total loss. Salvage Bid 1 $ Salvage Bid 2 $ Please upload the complete estimates with this claim report to Brotherhood Auto Aid. Signature of Applicant * signature keyboard Clear Estimates Upload Drop a file here or click to upload Choose File Maximum file size: 15MB If you are human, leave this field blank.