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Property Loss Worksheet
Property Loss Worksheet
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Form 2300F© 2004 Nationwide Publishing Company, Inc.http://www.claimspages.comPROPERTY LOSS WORKSHEETClaim Number: Insured:Claimant: Adjuster:Preliminary Estimate: $ Final Estimate: $1 2 3 4 5 6 7 8 9ITEM DESCRIPTION QUANTITY UNITS PRICE COSTAGE ORG. COST REP.COST DEPREC. A.C.V. LOSS -DAMAGEINSTRUCTIONS-Columns 4-9, unshaded column headings are for building or boat loss estimates. Unshaded columns 7, 8, and 9 areavailable for additional extensions such as deductions %, deductions $, total cost, etc. As required. Shaded headings are for use oncontents...
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The Adjusters Report/Certification form is similar to form 2110F but includes more detail regarding structural, contents and additional living expense payment recommendations. The adjuster certifies the loss and requests payment with this form.
Form 2350F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com INLAND MARINE PROOF OF LOSS POLICY NUMBER CLAIM NUMBER POLICY PERIOD AGENCY To company of By your Policy of Insurance above described, you insured (hereinafter called assured) according to the terms and conditions contained therein, including the written...
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Form 2170F © 2003 Nationwide Publishing Company, Inc. http://www.claimspages.com SWORN STATEMENT IN PROOF OF LOSS $ AMOUNT OF POLICY AT TIME OF LOSS POLICY NUMBER DATE ISSUED DATE EXPIRES AGENT To the of At the time of loss, by the above indicated policy of insurance you insured against loss by to the property described...
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