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Call 860.447.0385
Text 860.850.2842
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Home > Flood > Flood Property Loss Claim Form
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Flood Property Loss Claim Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
Alternate Phone Number
E-Mail Address *
Policy Number *
Loss Overview
Loss Type *
What date did the incident take place? *
/ /
How severe was the damage? *
Describe the Loss *
Submission Validation
Required

Important Notice
In order to protect your privacy, please do not send us your confidential personal information by unprotected email. Instead, discuss that personal information with us by phone or send by fax.

This information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. No payment, binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent or your insurance company. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Contact us 194 Colman St.
New London, CT 06320

Phone: 860.447.0385
Text: 860.850.2842
Fax: 860.440.3366
E: info@massadins.com
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