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PAY YOUR BILL
REPORT A CLAIM
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Forms

Home / Forms

Below are links to commonly used forms:

Employer’s First Report of Work-Related
Injury/Illness Claim Form


Employer’s Injury Claim Form

Employee Claim Form for Work-Related
Injury/Illness


Employee’s Injury Claim Form

Notice and Proof of Claim
for Disability Benefits


Disability Claim Form

Information for Certificate
of Insurance


Insurance Certificate Info

Motor Vehicle Report
Ordering Form


Vehicle Ordering Form

Macedon Office

66 Main Street Macedon NY 14502
315-986-4062
macedon@jdchapmaninc.com

Canandaigua Office

498 North Main Street Canandaigua NY 14424
585-394-5482
canandaigua@jdchapmaninc.com
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© 2023 J.D. Chapman Agency | Site Credit

  • Home
  • Personal
    • Personal Insurance
    • Auto Insurancecar insuranceAuto Insurance
    • Flood Insurance
    • Homeowners Insurance
    • Life Insurance
    • Other Vehicle Insurance
    • Renters Insurance
    • Travelers Traverse
    • Umbrella Insurance
  • Business
    • Business Insurance
    • Bonds
    • Business Owners Policy
    • Cannabis Insurance
    • Commercial Auto Insurance
    • Commercial Property Insurance
    • Employment Practices Liability Insurance
    • General Liability Insurance
    • Non-Emergency Medical Transport Insurance
    • Professional Liability Insurance
    • Workers’ Compensation
  • Quote Request
  • Payments & Claims
  • Resources
    • Forms
    • Frequently Asked Questions
    • Glossary of Insurance Terms
    • Helpful Links
    • Exit Survey
    • Claims Survey
  • About
    • About the Company
    • Macedon Office
    • Canandaigua Office
    • Staff Directory
    • Contact Us
  • Blog
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