CenterPoint Energy
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Claims Online Form

TYPE OF CLAIM

ELECTRIC OR GAS

Electric
Gas
Unknown

SELECT CLAIMANT INFORMATION

Self
Insurance Company
Other

SELF CLAIMANT INFORMATION

 
 
 
 
 
 
 
 
 

INSURANCE INFORMATION

 
 

OTHER RESPONSIBLE PARTY

 
 
 
 
 
 
 
 
 

INCIDENT INFORMATION

DAMAGES SUSTAINED

Property Damage
Auto Property Damage
Property Damage and/or Bodily Injury
Auto Property Damage and/or Bodily Injury

PROPERTY DAMAGE

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PROPERTY DAMAGE #2

Add/Remove Property Damage Section (+)

PROPERTY DAMAGE #3

AUTO PROPERTY DAMAGE

Yes (If yes, please insert insurance information below.)
No
***Auto claims may require a copy of the title ***

PROPERTY DAMAGE

Add/Remove Property Damage Section (+)

PROPERTY DAMAGE #2

Add/Remove Property Damage Section (+)

PROPERTY DAMAGE #3

BODILY INJURY

MEDICAL EXPENSES AND AMOUNTS

Expense
Amount
$
$
$

AUTO PROPERTY DAMAGE AND/OR BODILY INJURY

Yes (If yes, please insert insurance information below.)
No

BODILY INJURY

MEDICAL EXPENSES AND AMOUNTS

Expense
Amount
$
$
$

INSURANCE INFORMATION

Remove Insurance Information

WITNESS/REPORTING PARTY INFORMATION

   
   

SUPPORTING DOCUMENTS