CLAIMS SERVICES

Property Claims

To notify us of a property claim, please complete the information below.
Insured Information
* Required Fields
Insured: *
Address: *
City:
State:
Country:
Zip:
Home Phone: *
Business Phone:
Cellular Phone:
Fax:
Email: *

Policy Information
Policy Number:
Producer/Broker: *
Contact Name: *

Loss
Date of Loss: *
Type of Loss:
Location of Loss:
Probable Amount of Entire Loss:
Mortgagee:

Nature & Extent of Loss/Property Damage
Description of Loss & Damage:
Police/Precinct Report #:
Police Telephone:
Fire Department Report #:
Fire Department Telephone:
Business Interruption: Yes No
If Item is Scheduled,
Please Provide Description of Item & Item #:

Damage to Surrounding Properties
Name: *
Address: *
City:
State:
Zip:
Home Phone: *
Remarks

Reported By
Reported By: *
Telephone: *
Fax:
Email: *
Date Reported:

Contact Us
(516) 327-6300
info@bwd.us