Paramount Adjusters Form | Paramount Adusters

Skip to content

Call Paramount Adjusters today : (800) 593-2452

Search for:

HOME
ABOUT
WHY CHOOSE US
WHY HIRE AN ADJUSTER?
SERVICES
CONTACT
FREE CLAIM REVIEW

fire-damage-2

Paramount Form

We make it our business to ensure
you receive the settlement you deserve

Paramount Adjusters Form1xw5o2018-07-31T16:28:42+00:00

Please be as detailed as possible and if you have any questions, please call us on (800) 593-2452

YOUR INFORMATION

Named Insured

Second Name

Insured Location / "Loss" Location

City

State

Zip

YOUR CONTACT INFORMATION

First Name

Second Name

Phone Number

E-Mail Address

Mailing Address

City

State

Zip

CONTRACTORS INFORMATION (IF APPLICABLE)

First Name

Second Name

Company Name

Phone Number

E-Mail Address

Contractors Address

City

State

Zip

INSURANCE INFORMATION

Insurance Company

Claim #

Policy # & Policy Term

Date of Loss

How was the DOL determined? (i.e., onsite inspection/by whom?)

Referred by:

PERIL (Check Box or Boxes)

Fire

Water

Wind

Hail

Earthquake

Hurricane

Tornado

Damages (check box or boxes)

Roof

Siding

Windows

Interior

BI

EE

Landscape

Outbuildings

Data

Any waiver signed? If so, please list

Value of Loss

Payments Made

Denial Issued?

POL (Proof of Loss) Demanded (Date)

Prior Claims

Year Built

Major Improvements

Witnesses

Additional Comments & Notes

Have you received any of the following? (Please check box/boxes)

Photos

Policy

Paid Bills

Estimates

Communcations Between Insured & Insurer

ADDITIONAL ITEMS

Upload Documents or Images

This field should be left blank

COPYRIGHT 2025 PARAMOUNT ADJUSTERS. ALL RIGHTS RESERVED.