New Claim Assignment

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You may email your assignment to assignments@millenniumclaims.com
or use the form below. Our team is standing by!

Submitter
Policy Information
Loss Information
Instructions and Documents

Submitter Name*:

Submitter Company Name*:

Submitter Phone Number*:

Submitter Email*:

Insured Name*:

Policy Number*:

Start*:

End*:

Coverage Line:

Coverage Line*:

Amount of limit:

Coinsurance %:

RCV | ACV settlement:

Add Coverage Line

Deductible Breakdown:

Mortgagee Information:

Claim Number*:

Loss Date*:

Loss Type*:

Claimant:

Claimant Name:

Claimant Phone Number:

Claimant Email:

Contact*:

Primary Contact Name*:

Primary Contact Phone Number*:

Primary Contact Email:

Is there an alternate Contact?

Brief Description of Loss:

Loss Location:

Address*:

Address line 2:

City*:

State*:

Zip/Postal code*:

Add Location

Special Instructions:

Valuation Required:

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Millennium Claims Services

New Claim Assignment

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