ANCO Insurance: Property Loss Notice

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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Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. All submissions will be responded to within two business days.

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Disclaimer

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:
Address:
Phone #:	Work Home
Email:
Policy Number:

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:	(Address and Telephone)

Report Information
Reported by:
Title (if any):
Date:

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.

Anco Insurance
1111 Briarcrest Drive
Bryan, TX, 77802

979-776-2626
800-749-1733