Fire O&C

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Haag Fire O&C will contact you about submitted assignments within 24 hours, on business days, 8 AM to 4:30 PM. If your assignment is urgent, please call 214-290-8030.

Client Name(Required)

First Last

Company(Required)

Email(Required)

Phone

fax

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Policy Number

Claim Number

Date of Loss

Time of Loss

Policy Holder Name(Required)

First Last

Policy Holder Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person to Contact

First Last

Residence Phone

Business Phone

Contact Phone

Claimant Information

First Last

Claimant Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person to Contact

First Last

Contact Phone

Loss Location

Loss Description

Further Instructions & Info

Type of Investigation

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Fire O&C

Submit Assignment

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you

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