Property Assignment
Claim Number
Policy#
CAT Code
Date of Loss
Claim Type
Select
Commercial Property
Residential Property
Mediation
Appraisal
Umpire
Other
Description of Loss/Peril
General Assignment Instructions/Claim Info
Confirm Assignment Receipt
Email
Phone
Assignment Type
-Select
Full Adjustment
Task
Report Within
-Select
1-3 Days
4-7 Days
8-10 days
11-14 days
15-21 days
22-30 days
Other
Carrier/Client Information / Reporting Address
Carrier/Client Company
Claim Rep
Carrier/Client Mailing Address
Carrier/Client Email
Carrier/Client Phone
Carrier/Client Fax
Insured Name and Contact Information
Named Insured
Insured Mailing Address
Loss Location
Insured Email
Insured Phone
Instructions / Other Info Regarding Insured
Policy Information & Coverage Details
Coverage
Coverage Type
Limit
Deductible
Coinsurance
Forms
Additional Information
(Please include applicable loss notice, policy forms, etc...)
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