First Notice of Loss

"*" indicates required fields

Date*

Project Manager*

Job Type*

Residential

Commercial

Email of Person Filling Out Form*

Job Type*

Customer/Property Name*

Contact Name

Phone*

Job Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Management Company

Manager Name

Phone

Insurance Company

Adjuster

Phone

Claim #

Deductible

First Name of Referrer*

Last Name of Referrer*

Referral Company

Referral Type*

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Who Referred The Job? Property Manager? Agent? Adjuster? (Should not be ICI employee or phone or email)

Description of Loss / Special Instructions*

To ensure the safety of our team and protect your property, is there anything we should be aware of before arriving — such as pets, structural damage, or environmental hazards?*

Supporting material if applicable to the above

Accepted file types: jpg, jpeg, png, gif.

Comments

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First Notice of Loss

Locations

Projects Completed

Skilled Professionals