Property Loss Form

The following information is required to submit a Property Loss Claim. All information must be completed. Should you require assistance to complete this form, please contact your service representative.For more information check out our page on Property and Casualty Insurance for Nonprofits and for-profit Social Service organizations.

Fields marked with a red asterisk ( *) are required.

Sender Information
Upload Claim Support Material
  • Upload any claim support material you have, such as Police Reports, Hospital Reports and/or Internal Incident Reports

    Clear uploads

    Accepted file extensions: .pdf, .doc, .docx, .png, .jpg

  • Please enter the text in the image to help us verify that you are not a spammer.
    Use the blue buttons on the right of the image if you are having trouble.

  • You may also print and fax this form for processing to: (718) 389-4300