General Liability Assignment Form

Please complete and submit the following information regarding your claim assignment or email your assignment to NewClaims@custard.com. 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

Submitted By

Report To (if different from above)

Policy Information

Loss Information

Insured Information

Claimant Information

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