Self Storage Insurance Claim Form

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Storage Facility

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Loss


Approximate time of accident
Leave time at 12:00 AM if time is unknown

Date: Time:

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150

(Indicate on Description of Loss if you need to indicate more damaged items.)

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1000

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It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.

The Online Reporting System allows you to report your claim to Repwest at your own convenience and pace, twenty-four hours a day seven days a week. Please make sure that you have all your loss reporting details available to you as you begin the reporting process. Depending on the complexity of your loss, the online loss report should take between 5 and 10 minutes. If you cannot complete your claim, please end the claim and contact a claim service representative at 1-877-528-5674 to give a verbal loss report.

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