Report property damage as soon as possible. Complete what you know and return to info@iprotectinsurance.com or call 256-444-2041. Attach photos, estimates, and receipts if available.
IMPORTANT - WHAT TO DO AFTER A PROPERTY LOSS
Protect the property from further damage (tarp roofs, board windows, shut off water). Keep all receipts.
Take photos and video of all damage BEFORE cleanup or repairs begin.
Do NOT throw away damaged items until the adjuster has seen them or approved disposal.
For theft or vandalism, file a police report right away and note the report number below.
Talk to us before signing any contractor agreement or assignment of benefits.
Insured / Business Name
*
Policy Number
Insurance Company
Person Reporting
*
First Name
Last Name
Best Phone
*
Format: (000) 000-0000.
Email
example@example.com
Best Time to Contact
2 LOSS DETAILS
Date of Loss
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Address of Damaged Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cause of Loss:
*
Fire / smoke
Wind / hail
Water / plumbing
Flood
Theft / burglary
Vandalism
Lightning
Freeze
Falling tree
Vehicle impact
Collapse
Other
What Was Damaged:
*
Building / structure
Contents / equipment
Inventory / stock
Business income lost
Outdoor property
Other
Describe what happened and the damage (rooms/areas affected, items damaged or stolen):
*
3 CURRENT STATUS
Estimated Amount of Damage ($)
Temporary Repairs Made? Describe
Contractor / Mitigation Company
Is the property currently unusable or is business operation interrupted?
*
Yes
No
Is there any other insurance on this property, or a mortgagee company / lender to be listed?
Yes
No
Signature
*
Printed Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
FRAUD WARNING
*
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or who knowingly presents false information, is guilty of a crime and may be subject to fines and confinement in prison. (State-specific notices may apply.)
Preview PDF
Submit
Should be Empty: