Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player
AJ Benet Home Page About AJ Benet Insurance Personal Insurance from AJ Benet Business Insurance from AJ Benet Testimonials from Clients of AJ Benet Insurance Services for Clients of AJ Benet Insurance Insurance company partners with AJ Benet independent insurance brokers Contact the Professional Staff at AJ Benet Insurance


For a no-obligation consultation on homeowners, automobile, life, yacht, business, or group health insurance,
call 914-381-2040
and speak with
an experienced
A.J. Benet professional or email info@AJBenet.com

A.J.Benet Home Page > Client Services > Property Loss Notice

PROPERTY LOSS NOTICE

  

Please use the form below to notify us of any loss or damage to your property insured through this company/agency. Please note that this form is for notification purposes only and does not constitute making an actual claim. One of our representatives will contact you shortly after receiving this notification.
 

Disclaimer

I understand that this does not constitute an actual claim, but is rather a notification to my agent of an existing loss or claim, and may help expedite the claim process once I have filed.

 I have read and agree with the above disclaimer.

  (Box must be checked before request can be sent)

Policy Holder Information

Please be sure to supply your phone number and email address
so that we may contact you after receiving this notification.

Name Insured:

Address:

Phone #:

Work     Home

Email:

Time and Description of Loss

Time & Date of Loss

Time

a.m.
p.m.

    Date

Location of Property:

Description of Loss:

Authority Notification

Were the Police or Fire Dept. Called?

Yes     No

If Yes, which Authority?

Property Status

Is the Property habitable?

Yes     No

If No, where are you staying:

(Address and Telephone)

Report Information

Reported by:

Title (if any):

Date:


Additional Comments

Please give any additional comments you feel appropriate for this Loss Notice.


Please click on the "Submit Form" button to send your Loss Notice.
One of our representatives will respond to your submission as soon as possible.

   

Online Forms by ENHANCED Web Services
This Property Loss Notice Form Copyright © 2000 - by ENHANCED Web Services

Home | About Us | Personal Insurance | Business Insurance | Testimonials | Client Services | Insurance Partners | Staff Contacts | Site Map

A. J. Benet, Inc. • 430 Center Avenue • Mamaroneck, NY 10543 • Customer Service: 914-381-2040 • Sales: 914-381-0177 • Fax: 914-381-5089

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states.
For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

©2012 A.J. Benet, Inc. Insurance