Multiple Wildfire Loss Claim Form

Multiple Wildfire Claims

Accepted file types: xls, xlsx, Max. file size: 50 MB.

For each claim being referred on the spreadsheet, please provide all relevant information, including the following necessary details:

  • Referring Insurer
  • Insured Name
  • Claim Number
  • Date of Loss
  • Loss Location
  • Loss Amount Paid to Date
  • Reserves
  • Status of Adjustment (Open or Closed)
  • Adjuster's First Name
  • Adjuster's Last Name
  • Adjuster's Email Address
  • Adjuster's Phone Number
Name of Person Uploading Spreadsheet(Required)
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, xlx, Max. file size: 50 MB.
    Multiple files can be uploaded. Zip files are not supported