Assign a Claim

Hello world!
February 22, 2016

Assign a Claim

Peninsula Insurance Bureau
6065 NW 167 Street, Suite B1
Miami, Florida 33015
Fax 305.822.7060

To assign a claim to Peninsula Insurance Bureau, please fill out the following form or contact us by phone or email.

Date of Assignment
Company Assigning Loss
Company Address
Company City, State, Zip , ,
Company Phone Number
Company Contact Person
Contact Email
Insured City, State, Zip , ,
Insured Home Phone
Insured Business Phone
Date of Loss
Type of Loss
Location of Loss
Description of Loss
Policy Information
Policy Number
Policy Effective Dates to
Claim Number
Coverage Information:
Coverage A
Coverage B
Appurtenant Private Structures
Coverage C
Unscheduled Personal Property
Coverage D
Additional Living Expenses
Special Instructions

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