NOTICE OF LOSS
Please complete all fields below:
CP Insurance Associates
Date of Loss
Carrier
If you are reporting more than 30 days after Date of Loss, please explain the reason for the delay:
Details of Loss:
Did the loss render the property uninhabitable?
If so, are you claiming Loss of Rent:
Rent amount:
Rent payment schedule: monthly, bi-weekly, weekly, daily, etc.:
Loss Address
Type of Structure
Occupancy Status:
If vacant, list first vacancy date:
What is the age of the roof?
Is the property under construction of remodel?
Name of Contact Person for Scheduling Inspection:
Primary Contact Phone Number
Primary Contact Email address
Name of Insured
Insured's Mailing Address
Insured's First / Last Name
Insured's Phone Number
Insured's Email Address
Policy Number
Effective Dates:
Certificate Number
Effective Dates
Do you know of any other insurance that might apply to this property or this claim?
If so, please provide the details of the other policies:
Are you aware of any prior losses?
If so, date, details and outcome:
Is their a lender or lien holder on this property?
Agent or Lender
Agent or Lender Address
Phone
Email