AGIS Insurance Center - Report a Property Claim

Use the form below to report claims to our office. Claim reports will be submitted to your insurance company by our office the following business day.

If this is an emergency, after our office hours or during a weekend or holiday, please report your claim directly to your insurance company claim office:

Emergency Claim Reporting Numbers

Links to Insurance Company Websites

PROPERTY LOSS NOTICE

POLICY HOLDER INFORMATION
Please be sure to supply all if your contact information so we may promptly contact you after receiving this notification.
Name Insured:
Address:
Phone #:	Work Home
Email:

TIME AND DESCRIPTION OF LOSS

Time & Date of Loss

Time

a.m.
p.m.

Date

Location of Property:

Description of Loss:

AUTHORITY NOTIFICATION
Were the Police or Fire Dept. Called?	Yes No
If Yes, which Authority?

PROPERTY STATUS
Is the Property habitable?	Yes No
If No, where are you staying, so we may contact you	(Address and Telephone)

REPORT INFORMATION
Reported by:
Title (if any):
Date:

ADDITIONAL COMMENTS

Please provide and additional comments you feel appropriate for this Loss Notice.

DISCLAIMER:

I understand that by completing this form it does not constitute an actual
claim, but is rather a notification to my agent of an existing loss or claim,
and may help expedite the claim process once I have filed.

One of our representatives will respond to your submission as soon as possible.