AlaskaAdjusters.com

04 / 18 / 2024

Alaska!

Main Menu
Home Staff Weather Downloads Submit Claim Affiliates Technology

Claims Submission Form Company Company :: Name of your company. Adjuster Name Adjuster Name :: Your name goes here. Address 1 Address 1 :: Use the next two boxes for mailing and physical addresses. Address 2 City, State & Zip City, State & Zip :: Example: Anchorage, AK 99501 Office Office :: Your office phone number here. Fax Fax :: Your Fax number goes here. Cell Phone Cell Phone :: Your cell phone goes here. Email Address Email Address :: Your email address goes here. REQUIRED. Claim Number Claim Number :: Unique claim or file number your want referenced on the report. Claim Type Check All That Apply Auto Bodily Injury Coverage Issue Commercial Policy Fatality Fire Freeze Up Heavy Equipment Heavy Trucks Homeowners Policy Litigation Physical Damage - Insured Property Damage to Others Product Liability Theft Water Vandalism Check All That Apply :: Click the check box if it applies to your claim. Date of Loss Date of Loss :: Date of Loss is REQUIRED. Insured Contact Info Insured Contact Info :: Please provide as much contact information for the insured as possible including full name, address, phone numbers (home, office, cell, fax). Claimant(s) Contact Information Claimant(s) Contact Information :: Please provide as much contact information for the claimants as possible including full name, address, phone numbers (home, office, cell, fax). Fact of Loss : Also included any specific instructions for file handling Fact of Loss : Also included any specific instructions for file handling :: Describe facts of loss. Upload a File Upload a File :: Send an document to us; i.e. assignment sheet, policy, etc. We prefer PDF format. Joomla Professional Work