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General Liability Claim Form
Notice of General Liability Loss
Insured Name:
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Insured Address:
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Date of Incident:
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Time of Incident:
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AM
PM
Location of Incident:
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Name of Injured Party/Owner of Damaged Property:
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Injured Party/Property Owner’s Address:
*
Injured Party/Property Owner’s Phone Number:
*
Description of Occurrence:
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Name(s) and Phone Number(s) of any witnesses:
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Contact Name:
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Contact Email:
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Contact Phone Number:
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Please upload any other documents such as police reports, lawsuits, receipts, photos etc…
1. File Upload
2. File Upload
Attach a maximum of 10 files to each file upload field. A zip file containing multiple files counts as 1.
If you are having any issues uploading certain files above, please email your documents to:
claims@ib-tx.com
Additional Information: