School Insurance Fund Property Insurance Claim

Submitted by dclewis1 on Tue, 08/11/2020 - 09:21

Please complete all fields. If available, provide a reporting date, attach photographs, repair invoices, repair quotes, and any other pertinent information to support and document your claim.

This form will be automatically submitted to Brian Hood. If you have any questions, please call 919-647-0064 or email Brian.Hood@ncdoi.gov.

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Insured Name

Reporting or Contact Person

Title

Phone

Date Reported

Loss Date & Time

What time period did the loss occur?

Type of Loss

Other Type of Loss

Insured Location and Building Name

Description of loss: What happened and how?