Property Loss Notice - Vacant Express

A member of GBLI | Global Indemnity Your Partner for Specialty Insurance

Products
Agents
Policyholders
- Find an agent
Vacant Expert Blog
Contact Us
File a Claim
Make a Payment
Agent Sign In

Property Loss Notice

1Named Insured

2Contact

3Loss

4Final Remarks

I am the(Required)

Agency

Named Insured(Required)

Policy Number(Required)

Mailing Address

City

State

ZIP Code

Primary Phone Number

Phone Type

Home

Bus.

Cell

Secondary Phone Number

Phone Type

Home

Bus.

Cell

Email(Required)

Contact Info is the same as Named Insured

Yes

Name of Contact (First, Middle, Last)

Primary Phone Number

Phone Type

Home

Bus.

Cell

Secondary Phone Number

Phone Type

Home

Bus.

Cell

Contact's Mailing Address

City

State

ZIP Code

When to Contact

Location of Loss Address

City

State

ZIP Code

Date of Loss

MM slash DD slash YYYY

Time of Loss

Time of day

Type of Loss

If Other, please specify

Description of Loss & Damage(Required)

Previously Reported

Yes

Remarks/Other Insurance (list companies, policy numbers and coverages)

Reported By

Reported To

Disclaimer

By checking this box, I acknowledge that I have read and understand the above disclaimer.

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

By continuing to use our website, you agree to our cookie policy and privacy policy

800-310-3351

info@vacantexpress.com

Binding Authority Notices
EEO
FAQ

Contact Us
Sitemap

Terms & Conditions
Legal & Privacy Notices