Commercial Property Claim
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Begin
Policyholder
Loss
Summary
Begin The Claim
What is your relationship to the claim?
Policyholder
Claimant
Attorney
Agent
Other
*
Other relationship explanation
Your First Name
*
Your Last Name
*
Your Address
*
Your City
*
Your State
*
Your Zip
*
Your Home Phone
Your Work Phone
Your Extension
Your Cell Phone
Your Email
(A copy of this Web Reported Claim will be sent to the below e-mail address.)
Date of Loss
*
Time of Loss
Claim Type
*
Policyholder
Check if same as person reporting the claim
Yes
No
Company Name
*
First Name
*
Last Name
*
Address
City
State
Zip
Home Phone
Work Phone
Extension
Cell Phone
Email
Preferred Contact
Home Phone
Work Phone
Cell Phone
E-mail
Policy #
Mortgage Company
Loan #
Claim Details
Check if same as Policyholder
Yes
No
Loss Location
*
Building/Location#
City
*
County
*
State
*
Zip
*
Briefly describe what happened in the incident
Were local authorities notified or on the scene?
Yes
No
Agency Name/Precinct
Cause of Loss
Was occupant evacuated from the property address?
Yes
No
Is the property habitable?
Yes
No
Is there structural damage?
Yes
No
Catastrophe Codes
Estimated amount of entire loss
Summary
Your claim is now ready to submit.
Is there anything else that you would like to note?
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