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Report A Loss

 

Home Office

PO Box 447
635 Plank Road
Clifton Park, NY 12065

ph. 518-383-2102
fx. 518-383-2493

1-800-734-2102

 

Click here to print out and fax our Request For Service Form

Select Branch:

Name:
Address
City, State, Zip:
,
Home Phone:
Nature of Injury:
Aledged Disability:
Services Required:
IN-PERSON SIGNED STATEMENT CANVASS FOR WITNESS
IN-PERSON RECORDED STATEMENT PHOTOS OF SCENE
ACTIVITY CHECK PHOTOS OF PREMISE
SCENE INVESTIGATION/PHOTOS PROPERTY APPRAISAL GOLD (SCHEDULE)
INSPECTION OF PRODUCT/PHOTO PROPERTY- FULL ADJ. (SCHEDULE)
SECURE RECORDS PROPERTY- FULL ADJ. (TIME & EXP.)
Additional Instructions:

 

 

 
 
  
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