Flood Insurance
Proof of Loss
Policy Information
Policy Number
Claim Number
Insured Name
Property Address
Insurance Company
Date of Loss
Loss Details
Description of Loss (cause, location, extent)
Estimated Amount Claimed ($)
List of Damaged Property
Other Insurance
Other Insurance Coverage (if any)
Supporting Documentation
Details of Attached Documentation
Signature of Insured
Date
Adjuster Name
Adjuster Signature
Date