Helpico Insurance Agency - Property Loss Notice

Property Loss Notice

Property Loss Notice

Contact Information

Your Full Name: (as listed on policy now)
Your Email Address:
Daytime Telephone Number:

Description of Loss

Time & Date of Loss:	Time AM PM Date
Location:
Description of Loss:
Police or Fire Department: Notified?	Yes No
If Yes, Please Specify:
Is Property Habitable?:	Yes No
If No, Where Are You Staying: or Planning to Stay?	(Please include Address & Telephone #'s you can be reached at):

Mortgagee or Bank Information

Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

issue 20022

issue 2021-2022

issue 2021-2022

issue 2019-2020

for under and over 65

Agency NPN 17983521
Agency License 107813529

Disability Insurance