Date:
TO:	Bird Insurance Specialists, Inc.
Email:	newclaim@birdis.com
From:		Ext:
PRIORITY:	HIGH – Acknowledgment and 24 Hour Contact Mandatory! Report Due within 5 Business Days of Assignment.
Claim#:
	INSURED:		CLAIMANT:
Name		Name
Address		Address
Address2		Address2
City/ST/Zip		City/ST/Zip
Phone:		Phone:
Type of Coverage:
Policy #:		Deductible:
Applicable Policy Limits:
A:		B:
C:		D:
E:		F:
Date of Loss:		Loss Zip Code:
Loss Location:
INVESTIGATION REQUESTED:
Full Investigation w/ Captioned Report:
Limited Task Assignment (Please Specify)
Send Investigation Summary: by e-mail to: