Renters Insurance Claim Form
Personal Information
Full Name
Phone Number
Email Address
Rental Property Address
Policy Number
Incident Details
Date of Incident
Time of Incident
Incident Location
Type of Incident
Theft
Fire
Water Damage
Vandalism
Other
Description of Incident
Damaged or Stolen Items
List of Items (include make, model, value, etc.)
Police Report
Police Notified?
Yes
No
Police Report Number
Police Agency
Additional Information
Additional Comments or Information