PROPERTY LOSS CLAIM FORM

Property Insurance Information

Insured Details

Insured name *

Email *

Phone number *

Incident Information

Nature of Claim *

Property Type *

Water Type

Incident Date

Incident Time

Claim Number

Policy Number

Insurance Company Information

Insurance Company Name *

Adjuster Name *

Adjuster Email *

Adjuster Mobile Phone Num *

Adjuster Office Phone *

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Insurance Company Address

City

Province

Postal Code

General Information

Claim Details

info@floodtech.ca

400 Creditstone Rd Unit 19, Concord, ON Canada. L4K3Z3