Casualty Assignment Form

Please complete and submit the following information regarding your claim assignment or email your assignment to You may also call in your assignment to our HOTLINE at 1.888.CUSTARD/1.888.287.8273

Your assignment will be sent to our HOTLINE for immediate processing.

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Location of Adjuster Assignment

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Policy Information

Loss Information

Insured Information

Claimant Information

Witness Information

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