Assign a Claim

In this section you can assign a claim to our offices.
To assign a claim to G & G Insurance Adjusters, Inc. you can choose to either complete the information online or upload a document with all the information.

Assignor's Name: (required)

Assignor's Email: (required)

Assignor's Phone:

Insurance Company:

Agent

Agent and Location:

Agent's Phone:

Customer and Address:
(City, State, Zip)

Policy Number:

Policy Dates:

Customer Claim Number:

Insured

Last Name:

First Name:

Initial:

Property Address:

Zip:

Residence Phone:

Business Phone:

Mailing Address, if different:

Where can insured be contacted?

When?

Loss

Date of loss:

Time of loss: (AM/PM)

Location of loss if different than property address:

Police to whom reported: (Theft)

Kind of loss:(Fire, Wind, Explosion, etc.)

Probable Amount Entire Loss: $

Probable Amount This Policy: $

CAT. NO.:

Description of loss and damage: