Damage Assessment

Claim number or policy number

Primary phone number

Is your home still habitable despite the damage?

Yes No

Brief description of the loss/damage (Maximum : 100 words)

Brief description of the property affected (Maximum : 100 words)

Water heater damaged

Yes No

Kitchen cupboards damaged

Yes No

Stairs damaged

Yes No

Other items to mention that would have been damaged (optional)

You can upload photos of your damaged property after submitting this form

DAMAGE ASSESSMENT