General Liability Claim

Claim Date(Required)

Name Insured (Property Manager)(Required)

First Last

Property Management Company(Required)

Policy Number

Phone(Required)

Email(Required)

Property Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Landlord Name(Required)

First Last

Landlord Phone(Required)

Date of Incident(Required)

Description of Incident (Accident or Occurrence)(Required)

If available, please attach copies of any of the following materials:

Attachments

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Comments

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