Claims Submission

If you would like to print this claim form and submit manually, please click here to download and print the form.

Submission Number

Policy Number:

Date of Policy or Commitment:

Claimant Name:

Claimant Email: *

Confirm Claimant Email: *

Insured Name 1: *

Insured Name 2:

Claimant Mailing Address 1:

Claimant Mailing Address 2:

Claimant Mailing City:

Claimant Mailing State:

Claimant Mailing Zip:

Claimant Office Phone:

Please enter your 10 digit office phone number. Use ###-###-#### format.

Claimant Home Phone:

Please enter your 10 digit home phone number. Use ###-###-#### format.

Claimant Cell Phone:

Please enter your 10 digit cell phone number. Use ###-###-#### format.

If different than address above:

Insured Property Address 1:

Insured Property Address 2:

Insured Property City:

Insured Property State:

Insured Property Zip:

Attorney Representation

If you are represented by an Attorney, please provide the attorney's information. Note: Initial response to your claim will be made to your attorney.

Are you represented by an attorney?

Yes

Attorney Name:

Attorney Email:

Confirm Attorney Email:

Attorney Address 1:

Attorney Address 2:

Attorney City:

Attorney State:

Attorney Zip:

Attorney Phone:

Please enter Attorney's 10 digit phone number. Use ###-###-#### format.

Attorney Fax:

Please enter your Attorney's 10 digit Fax number. Use ###-###-#### format.

Claim Details

Please provide a description of your claim

Detailed Description: *

Date You Received Notice of Alleged Title Problem: *

Contact Information of Other Parties:

Current Status of Alleged Title Problem:

Have you been sued?

Yes

Please Note: If you have been sued, a copy of the Summons and Complaint, and, if applicable, the Answer filed on your behalf must accompany your Notice of Claim.

If yes, please provide the date you received papers:

If yes, has anyone filed a response of your behalf?

Yes

Comments:

Attachments

Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx xls xlsx.

NOTE: Attachments to this email are limited to a total size of 2 MB. If you have additional documents, please forward them separately, to newclaims@invtitle.com and reference the policy number or claimant name in the body of the email.

If "Submit Electronically" is selected above, then continue.

Please attach documents to your submission here. Please include, if applicable:

1. Copy of Your Policy
2. Copy of Summons and Complaint, including exhibits, if you have been sued.
3. Copy of any answer filed by you or on your behalf.
4. Any other correspondence or documents related to this matter including letters, emails, surveys, etc.

Electronic Signature

By electronically signing this notice, the undersigned acknowledge a duty under the policy to cooperate with the Company in the handling of this matter and in any litigation. The undersigned agree to provide any further information required by the Company.

Signature 1: *

Date 1 *

Month

Day

Year

Signature 2:

Date 2

Month

Day

Year

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