Commercial Claims Report Form

Date of Loss:

Insurance Company:

Policy Number:

Reported By:

Date Reported:

Insured Name:

Home Phone:

Business Phone:

Cell Phone:

Preferred Time to Call:

Address:

Policy Details

Building:

Contents:

Liability:

Deductible:

Location of Loss:

Cause of Loss:

Brief Description of Loss:

Police Notified:

YesNo

File Number (if applicable):

By clicking submit, I agree that the foregoing statements are true and correct to the best of my knowledge, and are submitted as a claim under the said policy.