Example_Insurance_Claim2_EA.pdf - Renteru2019s Insurance...

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Name _____________________________________________________________________________ Insured Address _____________________________________________________________________ City ____________________________________________ State _______ Zip Code _____________ Phone Number ______________________________________________________________________ Email address _______________________________________________________________________ What date did the loss take place? ______________________________________________________ Loss type (e.g. fire, theft) How severe was the damage? (e.g. minor, moderate, severe, unknown) Do you have evidence of the loss? If so, what? (e.g. police report, photographs, witnesses)

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