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Notice of Loss Submission - LLP

Please fill out the form below. An email will be sent to the address provided, confirming receipt of the information.

"*" indicates required fields

Who is reporting the loss?*

Property Manager

Lease Holder / Resident

Master Policy Number*

Property Management Information

Company Name*

Resident Number*

Community Representative Name*

First Last

Phone Number*

Email*

Community Address*

Street Address City State / Province / Region ZIP / Postal Code

Resident Information

Primary Contact*

First Last

Preferred Method of Contact*

Phone Number*

Email*

Loss Information

Loss Location Address*

Street Address Unit Number City State ZIP Code

Claim Type*

Choose one (if both, separate claims will need to be submitted)

Resident Caused Damage to Landlord Property

Damage to Resident Personal Property

Claim Cause / Tyle

Fire / Smoke

Lightening

Wind / Hail

Theft

Water Damage

Other

Date of Loss*

MM slash DD slash YYYY

Estimated Loss Amount*

Is the resident currently displaced?*

Yes

No

Was a Police / Fire Report Conducted?*

Yes

No

Description of loss (i.e., what happened?):*

Please upload any supporting documentation (i.e. Fire report, incident report, etc.)

Max. file size: 4 GB.

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Millennial Specialty Insurance, LLC is a licensed property and casualty agency in all states where products are offered.
Not all products are available in all states. In California, our agency is Millennial Insurance Agency, LLC (License #2K32091).