HOME ABOUT US OUR SERVICES CASUALTY FORM PROPERTY FORM SURVEILLANCE FORM INTERNET LINKS CONTACT US
Colonial Claims Service

PROPERTY ASSIGNMENT FORM

  • All required fields are marked with a red asterisk *
  • Please provide as much information as possible
  • Please attach claim documents in a separate email to
    frontdesk@colonialclaimsservice.com OR fax supports to 978-741-2343
 
*Description of Property:


Account information

 

*Assignor Insurer Agency

*Company:
*Claim No.:
*Adjuster/assignor name:
*City:
*Phone #:
*Date of loss: MM/DD/YYYY
*Address:
*State: *Zip code:
E-mail:

Insured Information



Name:
First: Last:
Company: (If Applicable)
*Address:
*City: *State: *Zip code:
*Phone #: *Contact:

Type of loss:


Policy Information


  Limit Deductible Insurance Endorsements
Coverage A:
Coverage B:
Coverage C:
Coverage D:
Other:

Agent information


Firm:
Address:
City: State: Zip code:
Contact:
Phone #:

Additional contacts:


First: Last:
Address:
City: State: Zip code:
Phone #:

Reporting Requirements:

*Initial Reporting:
Verbal 7 Days 21 Days 30 Days

*Subsequent Reporting:
21 Days 30 Days Other