DAMAGE ASSESSMENT

Step 1: Fill out the form

Be as precise as possible in your responses. Answer to the best of your knowledge.

Step 2 : Upload photos of your damaged property

When you click on the “Submit” button on this form, you will be directed to a web page explaining how to upload photos of your damaged property (if you have not already done so). If needed, click here to go directly to the photo upload page.

Identify yourself

First name

Last name

Claim number or policy number

Primary phone number

Email address

Details of the claim

Is your home still habitable despite the damage?

Yes No

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

/ 5000 characters

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

/ 5000 characters

Rooms damaged

Width

Lenght

or total area

Raised floor

Yes No

Stairs damaged

Yes No

Water heater damaged

Yes No

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Add a room add

Fill out before adding a room