Below, you will find the form that you will need to complete. You will need Adobe Acrobat to view them. Click Here to download the program if you do not already have it installed on your computer.
Notice and Proof of Claim For Disability Benefits Application Form (DB-450) >>
MV104 accident report form (MV104) >>
DBL Claims Department: Phone: 1 877 299 2442 Fax: 585 482 5132
Auto Claims Department: Phone: 718 706 7114 Fax:718 729 7833
