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Property Loss Notice

Please use the form below to notify us of any loss or damage to your property insured through this company/agency. Please note that this form is for notification purposes only and does not constitute making an actual claim. One of our representatives will contact you shortly after receiving this notification.

Please Note: It is highly recommended that you read and/or print this form in its entirety and gather materials or information for your responses prior to filling out the form online. Any information you input will be lost if you close your browser or navigate to another page or website prior to submitting your information by pressing the "Submit" button at the bottom of this form.

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I understand that this 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.

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)

Policy Holder Information
Please be sure to supply your phone number and email address
so that we may contact you after receiving this notification.
Name Insured:
Phone #: Work     Home
Policy Number:

Time and Description of Loss
Time & Date of Loss
       a.m. p.m.
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: (Address and Telephone)

Report Information
Reported by:
Title (if any):

Additional Comments
Please give any additional comments you feel appropriate for this Loss Notice.

Please click on the "Submit Form" button to send your request.
One of our representatives will respond to your submission as soon as possible.


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1111 Briarcrest Drive
Bryan, TX, 77802