NOTICE OF LOSS
Please complete all fields below:
Claim Information
Date of Loss
Insurance Carrier
Type of Loss
Description of Loss & Damage
If you are reporting more than 30 days after the Date of Loss, please explain the reason for the delay.
Contact Phone Number
Email address
Borrower Information
Loan Number
Loan Payoff Amount at Date of Loss:
Mortgage Type?
Is this loan Fannie Mae or Freddie Mac involved/backed?
Has the lender started foreclosure?
If so, when
Has foreclosure been granted?
Borrower First / Last name
Borrower Phone number
Lender Information
Lender
Contact Person:
Phone
Email
Lender Address
Policy Number
Policy Effective Dates
Certificate Number
Certificate Effective Dates
Supporting documentation may be requested, if applicable: