Resident Claim Submission

* Your Apartment Community’s Zip Code

* Community Name

* First Name

* Last Name

* Apartment Number

* Date of Loss

* Phone Number

2nd Phone Number

* Email

Do you have a Fire Report?

Yes

No

Do you have a Police Report?

Yes

No

* Cause of Loss Select... Fire Water Smoke Wind Hail Lightning Burglary Other

* Please Enter a Brief Description of Loss

Please attach the following documents (if applicable)

Pictures of the damaged items, List of items lost with replacement value, Fire Report, Police Report (Required for Burglary)


NOTE: You can select multiple files by holding the "Ctrl" key and clicking the files in the selection window.