Property Loss Notification Form - Financial Services Washington University in St. Louis

Date of Loss*

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)

Did your department purchase Floater Insurance on this property?*

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

Title of person submitting claim:*

Phone

This field is for validation purposes and should be left unchanged.