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Landlord Insurance Claim Form
Date of Loss:
Time of Loss:
Property Address:
Malicious Damage Y/N:
Rent Arrears Y/N:
List of items Lost/Damaged:
Property Manager Y/N:
Estimate of replacement/repair:
$
Technician report/replacement/Repair quotes obtained Y/N:
Brief Description of Loss/Damage:
Insurer:
Policy Number:
Excess:
$
Submit