Claim Filing Information

Name of Insured Association or Business: *

Property Manager or Contact Person: *

Contact Phone Number: *

Contact Email:

Please Note: Condominium or Community Association claims cannot be accepted directly from unit owners as all claims need to be filed by the Board of Directors or by Management.

Claim Information

Date of Occurrence: * +

Type of Loss: *

Claimant Name: *

Claimant Phone Number:

Claimant Email:

Claimant Address: *

Property Location Address: *

Unit Number(s):

City: *

State: *

Zip: *

Description of the Claim:

0/400 characters

If available, please attach any photos or suporting claim information:

Once the claim is assigned by the carrier, we will forward a claim number and the claim adjuster's name and contact information. Thank you for your time.