Name of Insured:
Policy Number:
Reported By: (Name)
Reported By: (Position) ie: Manager, Homeowner, Boardmember
Homeowner (Claimant) Name:
Property Address:
City:		State:
Zip Code:
Contact Information:
Daytime Phone:
Evening Phone:
Email Address:
Claim Information:
Date Discovered Loss:
What Caused the Loss:
Description of Damage:
Have Emergency Services Been Obtained: Yes No If Yes, What company? Phone Number:
Approximate Amount of Damage:
Do you have a personal Policy?	Yes No
Name of Carrier:
Personal Policy Number:
Property Deductible:
Management Company:
Phone Number:
Comments: