FNOL Claim Form

FNOL – Agent Claim Submission Form

This form is to assist you in quickly filing a claim for your client in the event of a named storm. It is intended for Agents Only. If you would like to speak to someone to assist with filing a claim, please dial our claims center at 561-609-1002.

Policy Information

Insured Name *

Policy # *

Property Address *

Primary Phone *

Alternate Phone

Insured Email Address *

businesssupport_SBP0316133

Claim Details

Reported By *

Relationship to Insured *

Agency Name *

Agent Phone Number *

Agent Email Address *

Date Reported *
Date should not be greater than the current date.

Date of Loss *
Date should not be greater than the current date.Date of loss cannot be after the date reported.

Incident Description *

SEVERITY

Is Power Intact/Available?

Is Roof Leaking?

Are there Wet Materials?

Is Home Livable?

Has the home sustained flood related damages?

Has the roof been tarped?

I confirm that I have thoroughly reviewed and provided the best possible answers to all your questions. I acknowledge that this submission serves only as the First Notice of Loss to People's Trust Insurance. It is important to note that this notice does not waive any rights or conditions that you, the policyholder, or People's Trust Insurance may have under the current policy's terms and conditions at the time of this loss.