UPUD | Claims Tracking

Claimant Information

First Name

Last Name

Phone Number

Date of Birth

Mailing Address

Please enter your mailing address information:

Number and Street (or P.O. Box)

City

Zip Code

Service Address

Is your service address the same as your mailing address?

Witness Information

Was there a witness?

Claim Information

Please provide the following information with regards to the occurrence or transaction, which gave rise to the claim you are asserting:

Date of Event

Time of Event

Place of Event

Give a general description of the indebtedness, obligation, injury or loss incurred so far as it may be known at the current time when presenting this claim.

Did a UPUD employee cause injury, damage or loss in relation to this claim?

Attach any photographs or pertinent documents you may have regarding this claim.

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