Property Loss Notification Form Property Loss Notice Form Date of Loss* MM slash DD slash YYYY Address or location of loss: (please specify building, floor, department, and room number)Description of loss: (explain what happened)*Please describe any action taken to limit the loss or prevent further damage:Person at department to contact: Phone Number:If this was a theft, were the Police or Protective Services notified? (you must notify the police if a theft has occurred) Yes No Did your department purchase Floater Insurance on this property?* Yes No If yes, what is your department #? Serial number of the item as it appears on your Floater Insurance schedule: Name of person submitting claim:* First Last Email* Title of person submitting claim:* PhoneThis field is for validation purposes and should be left unchanged.