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Flood Claim Form

HURRICANE DORIAN CLAIM NOTIFICATION FORM

  • Date Format: MM slash DD slash YYYY
  • (Please list all applicable policy #s)
  • THE INSURED
  • THE EVENT/LOSS TYPE
    Complete the applicable section(s) below to describe the loss you have incurred from a hurricane:
  • Property
  • Motor
  • Marine
  • PLEASE ATTACH ANY PHOTOS AND LOSS ESTIMATE DOCUMENTS YOU MAY HAVE IN YOUR POSSESSION TO SUPPORT YOUR CLAIM(S)
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
  • You can select multiple documents by dropping them here or by holding the CTRL button when selecting
  • VERY IMPORTANT - FRAUDULENT AND EXAGGERATED CLAIMS

    The above answers to our questions will be the basis of consideration of your claim. You must ensure that all information is true and correct to the best of your knowledge and belief, and that all material facts have been disclosed. A material fact is one that is likely to influence us in the assessment or acceptance of this claim, or one that is likely to influence our consideration of cover under the terms of your policy. If you are in any doubt as to whether a fact is material, you must disclose it.

    FAILURE TO DO THIS MAY MEAN THAT YOUR POLICY BECOMES INVALID AND A CLAIM PAYMENT WILL NOT BE MADE.
  • DECLARATION
  • PLEASE ATTACH A COPY OF A VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION DOCUMENT