Required Information
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Prepared by
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Loss Location/ Address
Insured Information
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Insured Name
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Insured Phone Number
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Insured Email
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Client Preferred Method of Contact
Claim Information
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Insurance Company
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Policy Number
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Claim Number
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Date of Loss
Claim Consultation
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What is the approximate age of the affected property? (i.e. Age of roof, age of wood flooring) # of years
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Has the Insured completed any mitigation or any temporary repairs on the property? (Roof tarp, window board, spent time cleaning up water from flooring)
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Were there previous payments made on the current claim?
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How many years has Insured been with Insurance company?
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Has the Insured filed previous claims for property damage with Insurance company?
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Does Insured have mortgage on property?
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Has the Insured obtained any estimates from contractors or repair professionals?
Personal Property and Loss of Use
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Did personal belongings or contents suffer damage?
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Is the home liveable?
