Georgia Public Adjusting, LLC

Residential Claim Assignment

Residential Claim Form

Please complete and submit the following information regarding your claim assignment or you may email direct to contactus@georgiapublicadjusting.com

You may also call in your claim to our team at 770-896-6000

Your claim will be sent to our team for immediate processing.
Required fields are marked with (required)

(Monday to Friday between 9:00AM and 5:00PM Central)

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Insured Property Loss Claimant Information

Insured Name on Policy (Residential Claim)

Insured Phone Number

Cell Phone

Fax Number

Property Loss Street Address

Property Loss City

Property Loss State

Property Loss Postal Zip Code

Insurance Detail

Insurance Company

Policy Number

Policy Effective Date (YYYY-MM-DD)

Date of Loss (YYYY-MM-DD)

Claim Number (if already filed with Insurance Co.)

Loss Details

Were Police Called?

Yes

Name of Police Dept.

Police Report Number

Was Fire Department Called?

Yes

Brief Description of Loss

Special Instructions/Immediate Actions required (Housing/Security/Remediation)