This form is to assist you with notifying People’s Trust Insurance Company that you would like to file a claim. If you would like to speak to someone in person, please dial our claims center at 1-561-609-1002.
Insured Name *
Policy #
Property Address *
Primary Phone *
Alternate Phone
Insured Email Address *
Reported By
Relationship to Insured SelfAgentAdditional InsuredAttorneyClaimant 3rd PartyContractor/TradesmanFamily MemberMortgageeNeighborPower of AttorneyPublic AdjusterTrusteeWitnessOther
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.
Was the cause of damage from a named storm? If so, which one?
Reason for Loss
Incident Description
Is Power Intact/Available?
YesNo
Is Roof Leaking?
Are there Wet Materials?
Is Home Livable?
Is this an Emergency?
How Do You Rate the Severity?
minimalModerateExtensive
Roof Type Built-UpConcreteMetalModified BitumenRolled RoofingShingle-ArchitecturalShingle-AsphaltShingle-WoodTile-ClayTile – concreteOther
# Stories
Gated Community
Gate Code *
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