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Claim for Property Damage
If you have been notified or are aware of a Claim for Property Damage or made against Board or Association by a third party, please complete this form.
Name:
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Address:
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City:
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State:
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Zip Code:
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Association:
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Owner Name:
*
Owner Phone:
*
Email address:
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Tenant's Name or N/A:
Tenant's Phone:
Unit Number:
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Owner's Insurance Company
*
Loss Information
Date of Claim:
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Approximate Time of Claim:
Incident Reported By:
Email Address:
Description of the Incident
Be as detailed as possible listing, who, when, and what happened, then complete the appropriate section(s) below (Personal Injury and/or Property). If this is a third-party claim, please provide copies of any correspondence received.
Description of the Claim:
*
Upload any correspondence you have received to date.
Was this a weather-related claim?
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Yes
No
If yes, please explain:
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Has any action been taken by the management company?
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Yes
No
NA
If yes, please explain:
*
Personal Injury Claims
Type of Claim:
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Injury (Guest)
Injury (Owner)
Injury (None)
Name of Injured Party:
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Current Condition of Injured Party:
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Address:
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City:
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State:
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Zip Code:
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Email Address
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Phone Number:
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Was a Child Injured?
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Yes
NO
If yes, witness name and contact information:
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Was there a witness?
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Yes
No
If yes, witness name and contact information:
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Property Claim
Type of Claim:
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Auto
Burglary
Fire
Flood
Hail
Windstorm
Vandalism
Sewer Back Up Damage
N/A
Is the current conditions the unit livable?
*
Yes
No
If no, please explain:
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Has a fire or water restoration company been contacted?
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Yes
No
NA
Name of Company:
*
Contact Email:
*
Contact Name:
*
Contact Phone:
*
Do you wish to only report this for record purposes only?
*
Yes
Please do NOT report claim
Please report claim immediately