Property REPORT A PERSONAL PROPERTY CLAIM For all other carriers, please complete the form below: Please enter the insured’s personal information so we can look up your policy and contact you regarding your claim. Name of Insured:(required) Mailing Address Line #1:(required) Mailing Address Line #2: City:(required) State:(required) Zip Code:(required) Policy Number: Contact Name:(required) Contact Phone:(required) Contact Email:(required) Location of Loss:(required) Description of Loss:(required) Has this loss been reported to the Police Department or Fire Department?(required) Yes No Terms: This claim cannot be considered filed under the notification guidelines of your policy unless you receive a reply from our firm. If you haven’t received a reply within 48 hours, please contact us via phone. If you have any additional paperwork, please fax to Robin Roberts 706-883-8915 after submitting this form.