Submit a First Notice of Loss
† Indicates a field is required when creating a claim.
* Indicates a field is required when creating a first notice of loss.
Policy Information
Policy Number †
Property Location Address †*
Unit/Apt/Ste
City †*
State †*
FL
Zip Code †*
Claimant Information
Who is reporting this claim? †*
Select One
Insured
Co-Applicant
Agent
Other
First Name †*
Last Name †*
How would you like to be contacted? †*
Home
Work
Cell
Email
Phone Type †*
Home
Work
Cell
Phone Number †*
Extension
Email
Insured Information
First Name †*
Last Name †*
How would the insured like to be contacted? †*
Home
Work
Cell
Email
Phone Type †*
Home
Work
Cell
Phone Number †*
Extension
Email
Loss Information
Is this a catastrophic event? †
Yes
No
Catastrophe †
Select One
-- N/A --
Do you know if there is damage to the home? †
Yes
No
Is home livable? †
Yes
No
Is there damage to your roof? †
Yes
No
Are you putting in a claim for a FEMA letter only? †
Yes
No
Is there any damage to the interior of your home? †
Yes
No
Is there any damage to other structures on your property? †
Yes
No
Are you putting in a claim for food spoilage or living expense reimbursement only? †
Yes
No
Is there water coming into your home? †
Yes
No
Are there any other areas or items damaged aside from the roof? †
Yes
No
Do you see areas of the roof missing? †
Yes
No
Is there heavy or minor interior damage? †
Select One
Heavy
Minor
Date of Loss †*
Cause of Loss †*
Select One
Additional Living Expense
Collapse
Collision
Cracking
Equipment Breakdown
Explosion
Fallen Tree
Fire
Flood
Food Spoilage
Freezing
Grease Fire
Identity Theft
Liability Animal
Liability BI
Liability PD
Lightning/ Fire
Hail
Lightning/Power Surge
Loss Assessment
Medical Payments
Mold
Mysterious Dis
Other Liability
Tornadoes
Other Physical Damage
Scheduled Loss
Sinkhole
Smoke
Theft
Unmanned Aircraft - Income Loss
Tile
Unmanned Aircraft - Medical Costs
Unmanned Aircraft - Other Than Medical and Income
Water Roof
Vandalism
Total Fire
Water Sewer B/U
Water Dishwasher
Water Heater
Water Washer
Water Shower Pan
Water Moisture Intrusion
Wind
Water Overflow
Wind/Flood
Water Pipes
Wind - Cat 01
Wind - Cat 05
Water Refrigerator
Wind - Cat 02
Wind - Cat 06
Unknown
Wind - Cat 03
Wind - Cat 04
Description of Loss †*
Additional Information
FNOL Information
FNOL Status †
Open
Converted
Closed - Duplicate
Closed - Lack of Interest
Closed - Damage Under Deductible
Closed - Other Insurance
Closed - Withdrawn