File a Claim – Unique Insurance Mobile/Manufactured Home

Are you an insured or representing an insured with Unique Insurance?*
- Yes
- No
*
- I'm presenting a liability claim
- I'm an Insurance Representative/Agent
- I'm a Medical Provider
- I'm an Attorney
- I'm a Contractor/Independent Appraiser
Reporter's Name*
First Middle Last
Reporter's Phone*
Reporter's Email*
Unique Insurance Policy Number*
Date of Loss*
Date Format: MM slash DD slash YYYY
Time of Loss*
: HH
MM
Location of Loss Address
Street Address Address Line 2
*
City State

LOSS DETAILS
Describe what happened in this loss*
Were the police notified?*
- Yes
- No
- Unknown
Police Department Name
Police Report Number
Reported Through
Was the Fire Department notified?*
- Yes
- No
- Unknown
Fire Department Name
Fire Report Number
Were there any witnesses to the incident not listed above?*
- Yes
- No
- Unknown
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Any Additional Comments?

Do you understand and accept these conditions?*
Yes, I understand and accept these conditions
Please take reasonable and prudent measures to preserve, protect and secure property from further damage. Take photographs of all damaged property and gather any and all receipts/invoices for lost, stolen, or damaged property in connection with this claim.

UNIQUE'S POLICYHOLDER INFORMATION