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WorldSource International Claims

Highlighted(*) items represent required fields. Please enter 'N/A' if any piece of information is not available and/or local Privacy Laws prohibit disclosure. 

Important Notice:
 This form does not eliminate the contractual requirement under our policy to forward every demand, notice, and/or summons received by the insured or their representative to the insurer. Nor does it eliminate the insured's obligation to comply with any filings required by any state or government agencies.

Commercial Property Claim Report Form

Basic Claim Details

 

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Insured Data

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Client Codes:

 
 
 
 

Loss Details

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Coverage Information

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Fire, Allied Lines Multi-Peril Policies (complete only those items involved in loss)

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Insert form numbers, edition dates and special deductibles
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List companies, policy nos., coverages and policy amounts
 
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