Personal Property Claim

Property Loss Notice

NO COVERAGE OF ANY KIND IS BOUND BY SUBMITTING INFORMATION VIA THIS ONLINE FORM.

Completion of this form does not constitute an actual claim, but serves to notify your agent of an existing loss or claim.

By completing this form, you are acknowledging your understanding of and agreement with these terms.
 
Your full name:
(as listed on policy now)
Your email address:
Daytime telephone number:
Description of loss:
Time & date of loss: Time AM PM
Date
Location:


Description of loss:
Police or fire
department notified?		 Yes No
If yes, please specify:

Is property habitable? Yes No
If no, where are you staying or planning to stay? (Please include address & telephone #'s
where you can be reached.):
Any additional information not requested above:
Additional information will be requested
upon receipt of this notice.
Also in Claims

FORREST SHERER
CLAIMS CENTER
24 N. 6th St.
Terre Haute, IN

If you have a claim and are having difficulty contacting your carrier, please contact us.
ph. 812.232.0441
fax 812.232.0926

If you prefer, report your claim to our office by clicking here.


   
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Forrest Sherer Insurance, 24 N. 6th Street, Terre Haute, Indiana 47807 - 812-232-0441