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First Notice Of Loss Form Template

Simplify the Claims Process with Our Customizable Form

Filing an insurance claim can be overwhelming, especially when detailing losses accurately from the start. This First Notice of Loss form template is designed for insurance professionals and clients alike, ensuring that you capture essential information early in the claims process. With this template, you can speed up claims processing, improve data accuracy, and enhance client communication, all while ensuring compliance with industry standards. Explore the live template to simplify your reporting.

Use this Template (FREE) Live Preview
Full name
Email
Phone number
Policy number
Type of claim
Preferred contact method
Phone
Email
Text message
No preference
Date of loss
Incident location (address or nearest landmark)
Brief description of what happened
Primary cause of loss
Please Specify:
Were police or emergency services notified?
Yes
No
What was affected? (select all that apply)
Building or structure
Personal contents
Business contents
Vehicle
Equipment or machinery
Electronics
Other
Please Specify:
Key details of the affected property or vehicle (e.g., unit number, year/make/model, serial/VIN)
Estimated amount of loss (currency and amount)
Ownership of affected property
Insured property
Third-party property
Shared or common area
Unknown
Witness name and contact (if any)
Third-party name or contact (if known)
Do you believe a third party is responsible?
Yes
No
Links to photos, videos, or documents (URL links only)
Immediate assistance needed
Emergency repairs
Temporary housing
Rental vehicle
Towing
Medical assistance
Board-up or secure property
None of the above
Availability for a claim call in the next 24 hours
Yes, any time
Yes, business hours
Yes, evenings
No, please email instead
I authorize the insurer to contact me and to obtain necessary information to process this claim.
Yes
No
Typed signature (full legal name)
Signature date
I certify that the information provided is accurate and complete to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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When to use this form

Use this form right after an incident that may lead to an insurance claim. It helps you capture the facts fast so your adjuster can triage, set reserves, and begin coverage checks. Common cases include a burst pipe soaking your ceiling, a break-in with stolen tools, storm damage to your roof, or a car backing into your fence. Report date, time, location, and a clear description while details are fresh. Add photos and any police or fire report number. For property losses, confirm policy details from your Home insurance declaration form. Prompt, complete reporting can speed repair approvals and payment.

Must Ask First Notice Of Loss Questions

  1. What happened, where, and when?

    This establishes the timeline and location so the claim can be verified and assigned to the right team. Clear facts help check coverage, deadlines, and local requirements.

  2. Were there any injuries or immediate hazards?

    This ensures safety actions and medical attention are prioritized. If injuries will lead to medical bills, you may later submit a Health insurance claim form.

  3. Which policy number and coverage apply?

    Providing the policy number, deductible, and limits speeds eligibility checks. Use your declaration page to confirm coverage types.

  4. Who was involved and how can we reach them?

    Names and contact details for you, witnesses, and any third parties reduce delays during investigation. It also supports subrogation if another party may be responsible.

  5. What evidence do you have right now?

    Photos, invoices, serial numbers, and any police or fire report number help validate the claim quickly. Uploading proof early reduces back-and-forth and speeds decisions.

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