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Insured Loss Information for Great Lakes Policies
Date of Loss
*
Month
/
Day
/
Year
Insured's Name
*
Contact Number
*
Email
*
Insured's Policy Number (If unknown, need carrier name)
*
Contact Person, if other than insured
Alt email/number
Location of Loss
Characterize Loss
Please Select
Minor (missing shingles/minor leaks or damage/damage to small other structures/fences, etc.)
Moderate (roof damaged but generally remains functional/multiple leaks and trees on property, but building remains usable and/or livable).
Severe (building destroyed or major structural damage, anything rendering the building unsafe or unusable).
Loss Details
Further Remarks. Anything they tell you may be helpful.
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