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E-mail address: Desk location:

Ins. Co / Office : Date: 02-06-2012

Claim No.: Phone No.:

Claim Rep: Loss Type:

Loss Date: Coverage Limit: or Ded Amt:

Insured: Phone:

Claimant: Assignment (check one): Settle or Inspec Only

Claimant Add:

Phone No.:
 
(Home)
(Business)

Loss Location:

 

Clmt. Contact Phone:

Special Instructions:

Please also include a police report, if you have it, and any other information that will help us locate the loss site
(JPEG, TIFF, PDF, DOC or ZIP files no bigger then 10MB per file).

You can e-mail us, any documents that you need to include, below. If you cannot e-mail our fax number is 914-245-7432

If you have more then three files to attach please use WinZIP to create one 10MB file or please use regular e-mail with Claim No. as the subject.

E-mail: office@smeservicesny.com