New Assignment

Are there multiple claimants under this claim number?

Yes

Additional Claimants will be added after clicking the Add Additional Claimants button at the bottom of the page.

Assignment Information

LOSS LOCATION*

New Location

Same as Insured

Same as Claimant

ADDRESS*

CITY*

STATE*

Not a Valid Zip! ZIP*

COUNTRY *

PHONE

EXT.

Injury / Damage / Coverage

PROPERTY DAMAGE COVERAGE LIMIT

IS THERE ANY CONCERN THAT THE PROPERTY DAMAGE MAY EXCEED THE POLICY LIMITS?

IS LIABILITY CLEAR?

IS COVERAGE CONFIRMED?

Attachments

HAS THE INSURED OR CLAIMANT PROVIDED YOU WITH ANY DAMAGE PHOTOS?

HAS THE INSURED OR CLAIMANT PROVIDED YOU WITH ANY DAMAGE APPRAISALS OR REPAIR INVOICES?

As always we will conduct our own inspection, take our own photographs and prepare our own estimate. However , depending on how the claim develops, we may need to contact you relative to the insured's or claimant's photos and/or estimates. If you wish to provide these attachments to us now , please attach any damage photos, repair invoices and repair estimates you may have on file using the upload option below.

New Assignment Form

Customer Information

Team Leader Information

Insured Information

Claimant Information

Assignment Information

Injury / Damage / Coverage

Attachments