If you intend to make a claim for personal injury or property damage under the Massachusetts 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Claimant Information section. Enter your first name, middle initial, last name, date of birth, social security number, street address, city, state, zip code, and phone number.
3. If applicable, provide details for an Official Representative who will receive all official notices. Fill in their first name, middle initial, last name, street address, city, state, and zip code.
4. Next, specify the Date and Time of the Incident. Ensure accuracy as this information is crucial for your claim.
5. Describe the Location of the Incident thoroughly. Include the closest street number and address.
6. If a City vehicle was involved in the incident, complete that section with relevant details such as employee name and vehicle information.
7. Provide a detailed description of the circumstances surrounding the incident. Attach additional pages if necessary.
8. Indicate whether you have submitted a claim to any insurance company and provide their contact information if applicable.
9. Finally, calculate and enter the total value of your loss or injury. Attach copies of all relevant bills and receipts.

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