KDH Adjusting logo

Professional Insurance
Claims Adjusters
Specializing in
Liability & Multi-line Claims
Throughout Northern California
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3261 Waterview Court
Hayward, Calfiornia 94542 		Off. (510) 247-1202
Fax (510) 247-1109

Submit a Claim

Date:
Insurance Company:
Examiner:
Address:
City/State/Zip:
Phone:
Claim Number:
Date of Loss:
Description of Loss:

INSURED
Insured:
Contact:
Address:
Work Number:
Home Number:
Cell Number:
Email Address:

CLAIMANT
Claimant:
Contact:
Address:
Work Number:
Home Number:
Email Address:
Cell Number:

ATTORNEY
Attorney:
Contact:
Address:
Phone:
Email Address:

INSTRUCTIONS FOR ASSIGNMENT - PLEASE BE SPECFIC

KDH Adjusting Services . 3261 Waterview Court . Hayward, CA 94542
510-247-1202 Office . 510-247-1109 Fax . kdhadjusting@aol.com