Departments for Wisconsin Applications & Supplementals : AMC/Fairmont

Departments for Wisconsin

Submit a Claim
"Please fill out the appropriate form listed below and email it to newclaims@amcins.com

NOTE: Please use Adobe Acrobat Reader 8.0 or greater for completing and submitting the following claim forms. Visit www.adobe.com to download the latest version."

Commercial Lines Excess & Surplus Lines / Binding Authority

Organized by category of coverage (Garage, Property, etc.), you will be able to easily sort through the forms we have provided to locate the one you need.

Employment Practices Liability

Find both the short and long form applications. All applications in this section can be filled out online, but you will need the latest version of Adobe Acrobat which can be downloaded by clicking the link below the applications.

Chartis
Torus - EPLI
AMC EPLI Online Tutorial / Webinar (click here to watch)

Fuel Marketers

Find the AMC Fuel Marketer Supplemental, which includes the underwriting guides, also UM, PIP, fraud and terrorism forms for all states AMC writes in.

Fuel Marketer Applications

PhysDam/Cargo/OccAcc

Pollution

Looking to obtain pollution coverage for a risk? We have placed the forms you will need for a submission in this easily accessable area of Agent Central.

Retail Service Station

Provides Service Station Application, along with all of AMC’s supplementals, fraud and terrorism forms, and other forms you need for a complete submission.

Body Shops
Gas Stations
AMC / Fairmont Service Station Application Applicable Supplemental Applications Three (3) year hard copy loss runs currently valued within the last 90 days.
Repair Garages
Truck Stops

Wine Related Business

Winery Package Program

Work Comp

Look here for all supplementals, questionnaires, notices and other applicable forms when submitting a risk to AMC’s Workers’ Compensation Department.

AMC Work Comp
Click Here for AMC CLAIMS REPORTING INFORMATION

Acrobat Reader is required to view the above documents, download it here if you do not already have it installed.

Caution If you experience problems with some of our PDF's please upgrade to the latest version of Adobe Acrobat Reader. Alternately, you may right-click the PDF link and choose 'save link/target as' to your desktop, once the file is saved to your desktop double-click it to open the form.