Forms and Reports

1005 Grand Ave • PO Box 65665 •

West Des Moines, IA 50265 • 515.223.1197

© 2024 Iowa-Missouri Conference of Seventh-day Adventists

File a Auto Claim

File a Auto Claim

Person Reporting Incident

Basic Claim Information

Church-Insured Vehicle Information


Damaged Property and Other Vehicle Information


File a Property Claim

File a Property Claim

Person Reporting Incident

This is who the insurance company will contact regarding the claim

Church Information

Claim Information

Church Attendance Form

Attendance Report

This Report Should be Completed Each Month Following the Final Sabbath.

Number of Sabbaths in the Month?

Below, Slide the Slider to Select the number of Sabbaths in the Month.


1st Sabbath

2nd Sabbath

3rd Sabbath

4th Sabbath

5th Sabbath