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120-200 East Beaver Creek Road, Richmond Hill, ON L4B 4V1
info@iconglobalconsulting.com
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Building Consulting and Project Management
ENVIRONMENTAL CONSULTING
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Home
About Us
Our Services
Building Consulting and Project Management
ENVIRONMENTAL CONSULTING
FORENSIC SERVICES
Contact Us
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120-200 East Beaver Creek Road, Richmond Hill, ON L4B 4V1
info@iconglobalconsulting.com
Home
About Us
Our Services
Building Consulting and Project Management
ENVIRONMENTAL CONSULTING
FORENSIC SERVICES
Contact Us
Submit an Assigment
Home
About Us
Our Services
Building Consulting and Project Management
ENVIRONMENTAL CONSULTING
FORENSIC SERVICES
Contact Us
X
Over 10 years we help companies reach their financial and branding goals. Maxbizz is a values-driven consulting agency dedicated.
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+1-800-456-478-23
411 University St, Seattle
maxbizz@mail.com
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Project Details
Assignment Information
Are you an Independent Adjuster (IA) or has one been assigned?
Yes
No
If you select yes, additional fields will appear to provide IA details
IA Company Name
(Required)
IA File #
(Required)
IA Contact Name
(Required)
First Name
Last Name
IA Contact Number
(Required)
IA Email Address
(Required)
Insurance Company
If multiple, please list all of them, or indicate 'Subscription'
Insurance Company Claim #
If multiple, please provide the lead claim #
Primary Contact Name
First
Last
Primary Contact Number
Primary Examiner/Contact Email
Address/Location of Loss
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Type of Peril
(Required)
Select One
Fire
Flood/Water
Wind
Hail
Spill
Other
Claim Type / Service Request
(Required)
Select One
Appraisal / Cost Consulting
Forensic Engineering (Structural)
Forensic Engineering (Cause & Origin)
Environmental
Peer Review / Subrogation Support
Other
Date of Loss (DOL)
MM slash DD slash YYYY
Is a Site Visit Required?
(Required)
Yes
No
To be determined
Policy Holder Name
First
Last
Policy Number
Policy Holder Contact #
Policy Holder Email
File Upload
File Upload
Additional Information
Additional Information
File Upload
Accepted file types: pdf, doc, docx, xls, xlsx, jpeg, jpg, png, Max. file size: 10 MB.
Loss details
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