Notice of Flood Loss

Date of Loss: *

Kind of Loss: *

Flood

Mudslide

Probable Amount of Loss-All Perils *

Policy Number: *

Policy Period (From, To): *

Insured Information

Insured's Name: *

Property *

Phone Number: *

Email Address: *

Mail Address: *

Phone Number: *

List any other insurance applicable to property including Homeowners, Wind and/or excess policy, coverage on specifically described articles, e.g. furs, jewelry, etc. Please provide policy numbers as applicable. *