File a Claim

INSURED
Name of Insured*
Policy Number
Please Select Account Manager*
Insured's Mailing Address

Street Address

Address Line 2

City

State

ZIP Code
Name of Contact
Primary Phone Number*
Secondary Phone Number
Contact's Email Address*
Contact's Mailing Address*

Same as Insured's Mailing Address

Street Address

Address Line 2

City

State

ZIP Code
LOSS INFORMATION
Date of Loss*

MM slash DD slash YYYY
Time of Loss
Location of Loss*
Kind of Loss*
Description of Loss & Damage*
Additional Remarks
Reported By*
Date*

MM slash DD slash YYYY
Pursuant to S. 817.234, Florida Statutes, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damaged property in support of a claim under an insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete, or misleading information concerning any fact or thing material to the claim commits a felony of the third degree, punishable as provided in S. 775.082, S. 775.083, or S. 775.084, Florida Statutes.

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Egis Insurance & Risk Advisors

(888) 232-3971

Boca Raton Office
150 East Palmetto Park Road
Suite 705
Boca Raton, Florida 33432
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Lake Mary Office
250 International Parkway
Suite 260
Lake Mary, Florida 32746
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File a Claim

INSURED

LOSS INFORMATION