Property Assignment Form Property Assignment Please note: * denotes fields that are required to be filled in. Your Name * Company * Company Address * City * State * Zip Code * Email Address * Phone Number * Fax Number Assignment Type * Full assignment - please handle to conclusion. Task assignment - please complete the following tasks: Task Assignment Estimate of Damages Photos of Damage Diagram Contents Inventory Agreed Price Scope of Loss Determine Cause of Loss Insured Recorded Statement C & O Investigation ITV Report Non-Waiver Agreement Proof of Loss Obtain Official Reports:Obtain Official Reports: OtherOther Policy Information * Residential Property Commercial Property Residential Property Insured Address City State Zip Code Home Phone Number Effective Dates From Effective Dates To Coverages, Limits, Deductibles, and Endorsements To Attach A Copy Of The Policy & Endorsement, See Attachment Sections Below. Commercial Property Insured Company Address City State Zip Code Home Phone Number Contact Name Position Policy # Effective Dates From Effective Dates To Coverages, Limits, Deductibles/SIRs, And Endorsements To Attach A Copy Of The Policy & Endorsement, See Attachment Sections Below. Claims Information Claim Number Date of Loss (mm/dd/yy): Time of Loss 121234567891011 : 0030 AMPM Location of Loss: Description of Loss Further Information or Instructions: Attachments File Upload Drop a file here or click to upload Choose File Maximum file size: 5MB File Upload Drop a file here or click to upload Choose File Maximum file size: 5MB File Upload Drop a file here or click to upload Choose File Maximum file size: 5MB Policy Information reCAPTCHA If you are human, leave this field blank.
