The Severt Insurance Agency - Offering Californians Affordable Earthquake Insurance

Property Loss Notice

NOTE: This service applies only to existing, current policy holders that have purchased their earthquake insurance through the Severt Insurance Agency.

Please provide the information requested below to initiate the claims process and one of our customer service representatives will begin working on your claim right away.

Name and Mailing Address of Insured

Name*
Address*
City*
State*
Zip Code*

Address of Property

Address*
City*	(California Only)
Zip Code*

Contact Information

Home Phone*
Work Phone
Email Address*
Where to Contact
When to Contact

Earthquake Policy Information

Policy Provider*
Policy Number*
Policy Start Date*
Policy Exp. Date*

Property Loss Information

Date of Loss*
Estimate of Entire Loss*
Additional Information

*Required Information