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
Cell
Work
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
Hail
Identity Theft
Liability Animal
Liability BI
Liability PD
Lightning/ Fire
Lightning/Power Surge
Loss Assessment
Medical Payments
Mold
Mysterious Dis
Other Liability
Other Physical Damage
Scheduled Loss
Sinkhole
Smoke
Theft
Tile
Tornadoes
Total Fire
Unmanned Aircraft - Income Loss
Unmanned Aircraft - Medical Costs
Unmanned Aircraft - Other Than Medical and Income
Vandalism
Water Dishwasher
Water Heater
Water Moisture Intrusion
Water Overflow
Water Pipes
Water Refrigerator
Water Roof
Water Sewer B/U
Water Washer
Wind
Wind/Flood
Wind - Cat 01
Wind - Cat 02
Wind - Cat 03
Wind - Cat 04
Water Shower Pan
Wind - Cat 05
Wind - Cat 06
Unknown
Description of Loss †*
Are emergency services needed?
Select One
No
Yes - Tarping of roof
Yes - Fire/Smoke damage
Yes - Boarding of door/windows
Yes - Standing water
Yes - Water/pipe leak
Yes - Roof leak
Yes - Fallen tree
Additional Information
***Please note we have partnered with pre-approved vendors that have been vetted to ensure your property is protected from further damage. This is a courtesy to you as a valued client as we want to make sure your most valuable possession is protected from any potential future damage. This is at no cost to you as the vendor will directly bill the carrier.***
FNOL Information
FNOL Status †
Open
Converted
Closed - Damage Under Deductible
Closed - Duplicate
Closed - Lack of Interest
Closed - Other Insurance
Closed - Withdrawn