Notice of Property Loss
After a loss, please report to APRA immediately and work quickly to prevent additional damage. Save all receipts for materials purchased to clean up and perform mitigation repairs. Prior to discarding any contents damaged in this loss, please make a content list of what was thrown away, photograph the item(s), if possible, and ensure the item is not salvageable.
Member & Contact information
Member Name
*
Broker Name
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Business Phone
*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Fax
Please enter a valid phone number.
Loss Information
Date of Loss
*
-
Month
-
Day
Year
Date
Time of Loss
Hour Minutes
AM
PM
AM/PM Option
Location of Loss
Cause of loss (fire, wind, theft, etc.)
Was the loss reported to the Police, State Troopers, or Fire Department
*
Yes
No
If reported, please submit a copy of the report filed for loss
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Description of damage
Please upload any photos you have of the damage
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Other important information
Additional insurance or remarks regarding the loss.
Submission
Name of the person submitting the form
First Name
Last Name
Title
Save
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