Landlord Insurance Claim Intake

Landlord Insurance Claim Intake — Form Fields

This legal template includes 16 fields. Intake form for landlords filing insurance claims for rental property damage or liability. Free to customize and use on ZenBuild.

• Landlord Name (text, required)
• Email (email, required)
• Phone Number (text, required)
• Property Address (text, required)
• Insurance Company (text, required)
• Policy Number (text, required)
• Date of Loss/Incident (text, required)
• Claim Type (dropdown selection, required) — options: Property Damage - Fire, Property Damage - Water, Property Damage - Storm, Property Damage - Vandalism, Theft, Liability - Tenant Injury, Liability - Visitor Injury, Loss of Rental Income
• Estimated Damage ($) (number, optional)
• Tenant Still Occupying Property (multiple choice, required) — options: Yes, No
• Property Habitable (multiple choice, required) — options: Yes, No, Partially
• Police Report Filed (multiple choice, optional) — options: Yes, No, N/A
• Police Report Number (text, optional)
• Description of Incident (long text, required)
• Photos of Damage (file upload, optional)
• Repair Estimates (file upload, optional)