Fraternal Property Claims

"*" indicates required fields

Loss Information

MM slash DD slash YYYY
(i.e. wind, hail, theft, etc.)

Main Contact Information

Name*

Secondary Contact Information

Name
Which contact will provide access to the house?
Was this reported to the Police Department?
Was this reported to the Fire Department?
Were emergency repairs required?
If yes, provide the contractor information below
Do you have a contractor selected to complete the repairs?
Contact Name
Name of person completing report
MM slash DD slash YYYY
Drop files here or
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 50 MB.
    Upload pictures, invoices, etc.

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    Nothing contained herein shall be construed as or constitute legal or tax advice. You have the right to, and should seek the advice of tax or legal counsel at your own expense. Third Party information contained in these materials have been compiled and obtained from sources believed to be reliable and credible but no representation or warranty, express or implied, is made by Holmes Murphy, or any of its subsidiaries or affiliates, as to their accuracy or completeness.
    ============================
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