Insurcomm Loss Information Sheet

Please complete as much information as you have available.

Condo Association Name:*
Street Address City State ZIP Code
Property Manager Name*
Property Manager Email*
Property Manager Cell Phone
Lock box # (If applicable)
Date Of Loss*
MM slash DD slash YYYY
Master Policy Information
Deductible Amount (If master policy is not affected please insert 0)*
Deductible (Select One)*
Insurance Company
Adjuster Name
Adjuster Phone Number
Claim Number
Unit Owner Information
Unit Owner Name
Loss Address
Street Address City State ZIP Code
Mailing Address
Street Address City State ZIP Code
Phone
Email
Insurance Company
Claim Number
Adjuster Name
Adjuster Phone Number
Tenant Information
Name
Phone
Were Multiple Units Affected? (If yes, click the + and add additional information)
- Yes
- No
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Loss