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Submit by Email DAMAGE INFORMATION REPORT PIPELINE SAFETY DIVISION State Form 54122 (R / 1109) INDIANA UTILITY REGULATORY COMMISSION Submitted to IURCPipeline Safety on: Who is submitting this information?
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How to fill out damage information report form
How to fill out damage information report form
01
Ensure you have a copy of the damage information report form.
02
Start by providing the necessary personal details such as your name, address, and contact information.
03
Identify the date and time of the incident that caused the damage.
04
Describe the damage in detail, noting the affected areas and any visible signs.
05
Include any relevant information about the cause or circumstances of the damage.
06
Attach supporting documents or photographs if available.
07
Provide details of any witnesses to the incident, if applicable.
08
Sign and date the form, confirming the accuracy and truthfulness of the information provided.
09
Submit the completed form to the appropriate person or authority.
Who needs damage information report form?
01
Individuals who have experienced any form of damage to their personal property.
02
Companies or organizations that have suffered damage to their premises, equipment, or assets.
03
Insurance companies requiring a comprehensive report to process claims.
04
Authorities or agencies involved in assessing and handling damage-related incidents.
05
Any party involved in legal or dispute resolution processes related to the damage.
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