FEMA Flood Proof of Loss

Type Your Email*

You will get this POL emailed to you once you click submit.

--- General Policyholder Information ---

**Flood POLs only require 1 policyholder's information. Please double check this information is accurate on both Policy and CF**

Initial or Amended POL?*

Name of Insured*

Only 1 policyholder needs to sign the Flood POL.

Name of Insured

Only 1 policyholder needs to sign the Flood POL.

Insured Phone Number*

Email of Insured*

example@example.com

Property (Loss) Address*

Street Address

Leave this Blank

CityState

Zip Code

Is Property Address same as Mailing?*

Yes (copy loss address to mailing)No (fill in mailing address below)

Mailing Address*

Street Address

Leave this Field Blank

CityState

Zip Code

Mailing Address:*

--- Policy Information ---

Flood Policy Number*

Flood Claim Number*

--- Loss Information ---

Date of Loss*

Date

Time

:HourMinutesAM/PM Option

**If this is a Hurricane claim, please choose the 1st option from the dropdown below**

How did the flood happen?*

Please advise your manager if another option is needed in this field.

--- Property and Mortgage Information ---

Type of Property*

Ownership/Use*

Owner-occupied means the owner lives in the home (but it could be year-round, seasonally- like a vacation home, or for commercial use). Tenant-occupied could be both for residential or commercial properties that are rented or leased.

Contents*

Choose the one that best describes the personal property in this claim. If there is NO contents coverage, please choose option 1.

Does this property have a mortgage?*

NoOther

Are there any others with interest or liens, charges or claims against the property?*

None (99% of the time this will be the answer)Other

--- Policy Limits, Deductibles and Our Estimate ---

**Do not put $ signs. Please use Commas and Periods.**

Coverage A: Amount of Coverage *

This is found on the policy/declarations page. This is the policy limits for Coverage A.

Coverage B: Amount of Coverage

This is found on the policy/declarations page. This is the policy limits for Coverage B. Add 0 if none.

Coverage A: Deductible*

This is found on the policy/declarations page.

Coverage B: Deductible

This is found on the policy/declarations page. Add 0 if none.

Coverage A: Amount Claimed*

This is the amount Bulldog wrote on our estimate.

Coverage B: Amount Claimed

Please leave EMPTY if we are not claiming Coverage B. Coverage B requires the policyholder to give us a contents/personal property list.

Please check the first 3 boxes for claims without contents and all 4 boxes for claims with contents.

Always check this box. "In completing this POL, I have used my own judgement concerning the amount of my loss."Always check this box. "We will be attaching at least one of the following:"A dwelling (building) estimateA contents (personal property) estimate

**The number below is prepopulated. Please confirm the math is correct.**

If NO Coverage B:

Net Amount= Coverage A: Amount Claimed MINUS Coverage A Deductible

If Coverage B Applicable:

Net Amount = Coverage A: Amount Claimed PLUS Coverage B: Amout Claimed MINUS Coverage A: Deductible MINUS Coverage B: Deductible

Net Amount Claimed = Amount Claimed - Deductible(s)

This is Coverage A and Coverage B Amount Claimed MINUS deductibles! This is auto calculated, please double check the computer's math. The Coverage B deductible should not be deducted if there is no Coverage B Amount Claimed