Hurricane Claim Form
Please fill out the form below correctly to assist us process your claims faster!
Name
*
First Name
Last Name
Mobile Telephone
*
Other Telephone
Email
*
example@example.com
Is there an additional contact?
*
Yes
No
Additional Contact
*
First Name
Last Name
Mobile Telephone
*
Other Telephone
Email
*
example@example.com
Are you insured with Inter-Ocean Insurance?
*
Yes
No
Our Insured's Name
*
Policy Number (if available)
Date of Loss
*
-
Month
-
Day
Year
Date Picker Icon
Time of Loss
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Loss
*
Automobile
Home/Property
Other
Location of Home/Property (Drag the red flag to the exact location)
More Specific Directions (if necessary)
Detailed Description of the Damage
*
Are you able to live in home/building?
*
Yes
No
Please provide the roof condition
*
No roof damage
Partial loss of roof or covering
Total loss of roof covering
Total loss of roof structure
Total loss - roof and walls destroyed
Did you file a police report?
*
Yes
No
Do you have a copy of the police report?
*
Yes
No
What's the police report number?
*
Upload police report
*
Take Pics/Browse Files
Cancel
of
Do you have an estimate?
*
Yes
No
Upload estimate
*
Take Pics/Browse Files
Cancel
of
Are you able to drive the vehicle?
*
Yes
No
Location of vehicle (Drag the red flag to the exact location)
*
More Specific Directions (if necessary)
Please take as many detailed pictures as you can
*
Browse Files
Cancel
of
Save
Submit Claim
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