ASSIGN A NEW CLAIM

Assigning a Claim

Company Assigning Claim:

Person Assigning Claim:

Contact's Email:

Contact’s Telephone:

Date of Loss:

Claim Number or Policy Number:

Insured’s Name and Address:

Loss Location:

Claimant’s Name, Address (If Different):

Type of Loss:

Specific Services Requested:

Deductible:

Policy Forms / Endorsements Further Information or Instructions:

Applicable Limits:

U.P. ADJUSTING SERVICES, LLC Independent Insurance Adjusters, is a multi-line independent adjusting service company.