| Field | Value |
|---|---|
| Customer claim number | |
| Policy number | |
| Loss date | |
| Notice date | |
| Loss cause | |
| Loss description | |
| City | |
| ST | |
| Zip code | |
| County | |
| Claim status | |
| Status date | |
| Coverage A | |
| Policy effective date | |
| Policy expiration date | |
| Times renewed | |
| Latitude | |
| Longitude | |
| Days open | |
| Hurricane deductible | |
| Deductible |
| Question | Answer |
|---|---|
| Give the address where you are staying now | |
| Best phone number to reach you | |
| Do you have any interior damage to the home | |
| How many rooms were impacted | |
| Describe the impacted rooms | |
| Describe any other damage to the dwelling or outdoor structures | |
| Who was home | |
| Does the claim involve bodily injury | |
| List the names of the injured people | |
| Do you have a contractor | |
| What is the name of the contractor | |
| What is the phone of the contractor | |
| What is the address of the contractor | |
| What is the license number of the contractor | |
| Is the home secure and livable | |
| What is preventing you from staying there | |
| Were the authorities notified | |
| What is the name and phone number of department that responded | |
| What is the report number |
| Question | Answer |
|---|---|
| Has water entered the dwelling | |
| Where is the water coming from | |
| Have you had any work done in the area of the leak in the last 3 years | |
| Is the age of the item leaking less than 5 years | |
| Approximately how long has the water been leaking | |
| Is there any visible or standing water | |
| Any wood floors base boards or carpeting still wet or moist | |
| Are any other items inside the home wet | |
| List all items that are wet | |
| Is there any signs of fungal growth or mold | |
| Have repairs been made to the active leak |
| Question | Answer |
|---|---|
| Did the theft occur on premises? | |
| How was entry made | |
| List the items taken | |
| Did you or your family members own all the items taken | |
| List items owned by other and who owned them | |
| Give the approximate total value of the items taken | |
| Were any of the taken items used for business |
| Question | Answer |
|---|---|
| List all the damaged items | |
| What is the name of person who put out the smoke alarm |
| Question | Answer |
|---|---|
| Is this loss due to a storm |
| Question | Answer |
|---|---|
| Is the roof damaged or penetrated | |
| Is there an opening in the roof | |
| What type of roofing material does your home have | |
| Has your roof been replaced before? | |
| Please indicate the year of roof replacement | |
| Have you noticed any of your roofing material missing or found your roofing material in your yard |