HEAD OFFICE: 1 Gray Street, St Clair
868-285-4853
868-628-0272

Preliminary Notice of Loss Form

Please fill out the form below and submit online. You will be contacted once received and reviewed.

Preliminary Notice of Loss

  • 6th September, 2017

  • Please type your name in lieu of actual signature
  • This is official submission date for record

HOW TO FILL IN PRELIMINARY NOTICE OF LOSS

  1. “Name of Insured”- name of policyholder as appears on your insurance Policy Schedule.
  2. “Address”- the address as appears on your insurance Policy Schedule.
  3. “Date of Loss”- the date on when the hurricane struck.
  4. “Location of Loss” – complete if the location of loss is other than your address above. If similar insert “same as above”.
  5. “Policy Number”- as located on your policy- e.g. FPC-12345 or if Motor Vehicle Registration number and Vehicle type
  6. “Contact Numbers” – provide us with your cellular, land line number, e-mail, etc. so we could reach you.
  7. “Agent” – if you had purchased your insurance through one of our agents, please provide name of agent. If policy was bought from our main office, leave blank.
  8. Provide us with your preliminary estimate for repair whilst you obtain a repair quotation from local contractor/repairman/mechanic.
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