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: