edjuster - Submit a Claim

* indicates a required field

Adjuster / Claim Information

Insurance Company

Insurer Claim Number

Adjuster Name (main claim contact)

Adjuster Email

Adjuster Phone Number

Independent Adjuster Company (if required)

Independent Adjuster File Nº

Examiner Name for Insurance Company (if required)

Examiner Email

Examiner Phone Number

Date of Loss

Content Loss Estimate $

Policy Limit $

Deductible $

Special Limits

edjuster Services Requested

Details

Policyholder Information

Name(s)

Address

Zip / Postal Code

City

State / Province / Region

Email Address

Mobile Phone

Home Phone

Business Phone

Contractor Information (if applicable)

Contractor Company Name

Contractor Contact Name

Contractor Contact Email

Contractor Contact Phone Number

Notes / Safety Issues

File Attachments

Please attach supporting files or documents, such as a Content List or Schedule of Loss. Native Excel format is preferred for faster processing, but we accept all file types. If you are unable to upload the documents, please contact claims@edjuster.com and reference your claim and/or file number.

Limit of 10 files. Maximum individual file size permitted is 15 megabytes.

File Name	File Size	Actions