Insurance Claim Submission Form

Rockingham Insurance customers, did you know you can file and track your claim with your online customer portal? It's easy just go to ROCKINGHAM.insure and sign in to your portal (or sign up if you do not have an online account yet).

Are you filling out this form on behalf of someone else?

Is this person a current Rockingham Insurance Customer?

Are you a current Rockingham Insurance customer?

Your Name

First NameLast Name

Name of person you are completing the form for:

First NameLast Name

Address

Street Address

Street Address Line 2

CityStateZip Code - 5 digitCountry

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

What is your preferred contact method?

Insurance Company

Policy Number

Name of the Rockingham Insurance customer involved:

First NameLast Name

Rockingham Insurance customer's policy number:

Rockingham Insurance Customer's Vehicle Information

Your Vehicle Information