Property Claim Claim #* Policy # CAT Code Date of Loss* Claim TypeSelect valueCommercial PropertyResidential PropertyMediationAppraisalUmpireOther Confirm Assignment ReceiptSelect valueEmailPhone Description of Loss/Peril General Assignment Instructions/Claim Info Assignment TypeSelect valueFull AdjustmentTask Report WithinSelect value1-3 Days4-7 Days8-10 Days11-14 Days15-21 Days22-30 DaysOther Carrier/Client Company Carrier/Client Mailing Address Street Address City State / Province / Region Postal / Zip Code Claim Rep Carrier/Client Email Carrier/Client Phone Carrier/Client Fax Named Insured* Insured Email Insured Phone* Instructions/Other Info Regarding Insured Insured Mailing Address* Street Address City State / Province / Region Postal / Zip Code Loss Location*Same as Mailing AddressDifferent Address Loss Location Address* Street Address City State / Province / Region Postal / Zip Code Coverage Type 1 Deductible 1 Limit 1 Coinsurance 1 Forms 1 Coverage Type 2 Deductible 2 Limit 2 Coinsurance 2 Forms 2 Coverage Type 3 Deductible 3 Limit 3 Coinsurance 3 Forms 3 Coverage Type 4 Deductible 4 Limit 4 Coinsurance 4 Forms 4 Coverage Type 5 Deductible 5 Limit 5 Coinsurance 5 Forms 5 Upload a File 1 Upload a File 2 Upload a File 3 Upload a File 4 Upload a File 5 Upload a File 6 Upload a File 7 Upload a File 8 Upload a File 9 Upload a File 10 reCAPTCHAThe combined size of all files cannot exceed 24 MB in TOTAL.After clicking Submit, please wait for the green "Your Form Was Successfully Submitted" message to appear. If you do not see a confirmation message, your form may not have been submitted successfully and you should try again.If you do not receive an email acknowledgement from us within 24 hours, please email assignments@davisclaimsservice.com or call 888-328-4785 opt. 1.SubmitReset
