AmRisc, LLC
This form is for agent use only. Insureds please contact your current agent to report a claim. Agents, please fill in the Property Loss Notice and e-mail to, fax to 252-726-2855 or complete the form below. You will receive an acknowledgement from AmRisc within 72 hours.
Policy Number:*
Name and Address of Insured:*
Contact Name:*
Date and Time of Loss:*
Business/Cell Phone:*
Address of Loss:*
Email Address:
Description of Loss and Damage:*
Contact Name:
Remarks/Other Insurance:
Contact Phone:
* Indicates a Required Field

Any Person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: Substantial) civil penalties.  (Not applicable in CO, HI, NE, OH, OK, OR, or VT; or DC, LA, ME, TN and VA, insurance benefits may also be denied.)
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