Claim Assignment Sheet
The completed assignment sheet below can be submitted to us for
immediate handling, or the sheet can be printed and faxed to our office
at (207) 282-8362 for immediate attention.
For questions or further instructions, please call us at (207) 284-2200.
Company
Date
Person
Assigning
Phone
Company
File #
Canadian File? Y N
Assured
Address
Contact
Person
Phone
Aircraft /
Vehicle
Data

Yr
Make
Model		 Registration
N (US) or C (Canadian)
Policy
Data

Number
Effective Dates
Agent
Limits

Liability
Hull
Deductible
Claimants,
Phones,
Addresses
Loss Date
Location Fatality? Y N
Details
of the
Loss
Notes