Theft/Vandalism Property Damage Claim Form
Claimant Information
Full Name
Phone Number
Email Address
Address
Property & Incident Details
Date of Incident
Time of Incident
Location of Incident
Type of Incident
Theft
Vandalism
Other
Description & Damage
Description of Incident
Property/Items Damaged or Stolen
Estimated Value of Damaged/Stolen Items
Additional Information
Was a Police Report Filed?
Yes
No
Police Report Number
Additional Comments