Graham Restorations

Insurance Claims

Insurance Claim Form - Submitted by Company . . .

COMPANY INSURANCE CLAIM NOTICE :
 
  Insurance Co.   Claim No.   Date of Loss
     
           
  Adjuster   Agent   Deductible $
     
           
Details of Insured:
 
Name :   Loss at    
Address :   Address :
  :     :
City :   City :
Province :   Province :
Postal Code :   Postal Code :
             
Phone (Res) : -   Phone (Bus) : -
 
Comments :
     
Type of Loss :
     
Explain if Other :
     
Remarks :