Atlas Property Loss Notice
| Step 1 - Insured Information | |
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Company:
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Policy Number:
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Name and Address of Insured:
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eMail:
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Fax:
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Home Phone:
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Business Phone:
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Name and Address of Spouse:
(if applicable) |
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| Step 2 - Contact Information | |
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Contact Name and Address:
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eMail:
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Fax:
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Home Phone:
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Business Phone:
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| Step 3 - Loss Information | |
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Location of Loss:
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Police or Fire Dept. to which Reported:
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Probable Amount Entire Loss:
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Description of Loss & Damage:
(use separate sheet if necessary) |
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| Step 4 - Policy Information | |
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Mortgagee:
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Bank Name and Address:
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Account Number:
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ABA/Routing #:
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Adjuster Assigned:
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Reported By:
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Reported To:
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Filling out this form is not the equivalent of contacting the Insurance Company which is a requirement as expressed in your contract of insurance. This form is only a tool to help speed up the claim process.
If you have any further questions, please call us at the numbes listed below.
