Assignment-Form | Fine Arts Insurance Consultants

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Assignment-Form

If you are unable to submit the form below, please click the “Download Form” button and email the completed form to info@fineartsinsuranceconsultants.com

Company Name *

Adjuster's Name *

Adjuster's Title

Address

City

State

Zip

Email Address *

Today's Date

Phone

Fax

Cell

Claim #

Date of Loss

Type of Loss

Insured

Claimant

Home #

Cell #

Work #

Address

City

State

Zip

Permission to Contact the Insured/Claimant
YesNo

Insured/Claimant is represented by:
COUNSELP.A.NONE

Please select the item which best fits your needs:
Second OpinionAppraisal AnalysisReplacement CostDiminished ValueACVCurrent Market ValueRestoration EstimateAuthentication Service

Notes / Subject of Claim

Please upload your photos here:

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