Property Loss Notice

Please use the form below to notify us of any loss or damage to your property insured through this company/agency. Please note that this form is for notification purposes only and does not constitute making an actual claim. One of our representatives will contact you shortly after receiving this notification.

» Required Fields

Property Loss Notice


I understand that this does not constitute an actual claim, but is rather a notification to my agent of an existing loss or claim, and may help expedite the claim process once I have filed.



Policy Holder Information



Please be sure to supply your phone number and email address so that we may contact you after receiving this notification.




Time and Description of Loss


A.M. P.M.


Authority Notification


Were the Police or Fire Deparment. Called? Yes No


Property Status


Is the Property Habitable? Yes No


Report Information



Additional Comments



Please give any additional comments you feel appropriate for this Loss Notice.


Jacks & Associates
5707 Southwest Pkwy, Bldg 2 Ste 400
Austin, TX 78735
Phone: 303-987-0042 Fax: 303-987-0424