Property Loss Assignment,Delaware Claims Assignment,Claims Adjuster

Property Loss Assignment

Client Information/Reporting Address

Please provide as much information about the claim as possible
Required fields are marked by the symbol essential

If you do not have the information for a required field, please enter "unknown"

essential field Client Company Name

essential field First Name

essential field Last Name

Mailing Address
Building/Suite	City

essential field State

essential field Zip

essential field Phone

Ext

essential field Fax

— —

essential field Email Address

Claim Details and Assignment Type

essential field DOL(mm/dd/yyyy)

essential field Claim/file #

Policy #

essential field Type of Property Involved

Residential

Commercial

Industrial

CAT Code

essential field Description of Loss/Peril

essential field Please enter the scope of your assignment

Site Investigation	Settlement Authority	Determine Cause And Origin
Interview Insured	R/S Insured	R/S Employee/ Witness
Appraise Claiment Vehicle	Determine Damages	Property Estimate
Photos/Diagrams	Subrogation Investigation	Determine Liability
Handle Salvage	Call Client A.S.A.P.	Call Client From Scene
Call Back w/Figures	Obtain Police Report	R/S Claimant
Others - See Comments

Additional Instructions and Comments

essential field Please select the type of Assignment

Full Assignment

Partial Assignment

Appraisal only

essential field Confirm Assignment Receipt

E-mail

Phone

By 1st Report

essential field Report Within

24 Hours

3-7 Days

7-15 Days

15-30 Days