Fillable blank notice of claim form for property loss
PROPERTY LOSS NOTICE
MISCELLANEOUS INFO (Site & location code) DATE OF LOSS AND TIME
DATE PREVIOUSLY REPORTED
PHONE (A/C, No, Ext):
POLICY TYPE PROP/ HOME CO: POL: CO: FLOOD CODE: AGENCY CUSTOMER ID WIND POL: SUB CODE: POL: CO:
COMPANY AND POLICY NUMBER
EFF: EXP: EFF: EXP: EFF: EXP:
NAME AND ADDRESS OF INSURED DATE OF BIRTH
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You must file a claim with the State Controller’s Office.
... Please refer to the filing instructions for a list of acceptable documents to include with your claim.
... Unclaimed Property Claim Affirmation Form.