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New Assignment for TRISTAR Claims Management Services, Inc.
Your Contact Information
First Name
Last Name
Company
Address
(Line 1)
(Line 2)
City
State
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
ZIP
Phone:
eMail:
New Assignment Information
Your Claim #:
Assignment Instructions:
Characters left:
Insured's Information
Policy #:
Phone #:
Alternate Phone #:
Company:
First Name:
Last Name:
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Mortgagee:
Loss Location
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Claimant Information
(if applicable)
First Name:
Last Name:
Phone:
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Agent Information
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Hide
First Name:
Last Name:
Company:
Office Phone:
Cell Phone:
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Country:
Loss Information
Date of Loss:
Type of Loss:
Subrogation
ISO
Products Liability-PD ( Claims Made)
Errors & Omissions Liability (Claims Made)
Products Liability-BI (Claims Made)
Bodily Injury
Cargo
Casualty
Collision
Comprehensive
Defamation
Drowning
Employee Dishonesty
Fire
Heavy Equipment
Incident Only
Liability
Product Liability
Property Damage
Hail
Mold
Theft
Vandalism
Water
Wind
Slip & Fall
Business Interruption
Emotional Distress
Construction Defect
SML - USAS
SML - Clubs
Automobile
Fast Track GL - PD
Discrimination
Appraisal
Credit Card Subro
ISO - Subro
ISO - Investigation
ISO/ PD Report X2
Turo Cancelled Claim
Plate Check
Plate Check - Subro
Garage Keepers Legal Liability (GKLL)
Investigation
Automobile Property Damage (APD)
Police Report
Automobile Bodily Injury (ABI)
General Liability
Claim
Arbitration
BOC
Third Party Uninsured
Employment Practices Liability
Lightning / Electrical
UM
UM - Subro
ISO - UM
Police Report - UM
Cancelled Claim
Policy Insights
Unit:
Renters Carrier
3rd Party Claimant Carrier
Appraisal
Commercial Property
Homeowners Property
General Liability
Homeowners Liability
Premises Liability
Products Liability
Auto Collision
Commercial Auto
Personal Auto
Cargo
D&O
Heavy Equipment
Public Entity
SML - USAS
Subrogation
SML - Clubs
Marine
Renter
Turo Cancelled Claim
Garage Keepers Legal Liability (GKLL)
Automobile Property Damage (APD)
Automobile Bodily Injury (ABI)
Child Injury
Cut/Scrape
Trip/Slip&Fall-Inside Store
Trip/Slip&Fall-Outside Store
Bike Test Ride
Fixture
Front Doors
Other/No Fault
Claimant
BOC
Workers Compensation
Cancelled Claim
Type of Adjustment:
Limited
Full
Loss Description:
Characters left:
VIN #:
Deductible:
Wind Deductible:
Coverage A
* Legal Expense
* Non-Legal Expense
* Expense
* Building
* Contents
* Other Property
* Extra Expense
* Inland Marine - All Other Scheduled Items
* Inland Marine - Contents Off Premises
* Inland Marine - Contents On Premises
* Income Loss
* Other Liability
* Bodily Injury
* Non-Vehicle Damage
* Vehicle Damage
* Claim
* No-Fault Basic
* No-Fault Excess
* No-Fault NY Optional
* Loss of Use
* Uninsured Motorists BI
* Underinsured Motorists BI
* Underinsured Motorists PD
* Uninsured Motorists PD
* Other Indemnity
* Permanent Disability
* Temporary Disability
* Vocational Rehab - Evaluation
* Vocational Rehab - Indemnity
* Vocational Rehab - Training
* Employers Liability
* Retired - WC Indemnity Misc
* Medical
* Retired - WC Medical Misc
Indemnity BI
Indemnity PD
Expenses Adjusting
Expenses Legal
Expenses Other
Business Personal Property
Building 1
Medical Payments
SML - Clubs 5000-020
Collections / Recovery
Towing
Appraisal Fee
Administrative Fees
Diminished Value
Deductible
Expense Coverage
Coverage B
* Legal Expense
* Non-Legal Expense
* Expense
* Building
* Contents
* Other Property
* Extra Expense
* Inland Marine - All Other Scheduled Items
* Inland Marine - Contents Off Premises
* Inland Marine - Contents On Premises
* Income Loss
* Other Liability
* Bodily Injury
* Non-Vehicle Damage
* Vehicle Damage
* Claim
* No-Fault Basic
* No-Fault Excess
* No-Fault NY Optional
* Loss of Use
* Uninsured Motorists BI
* Underinsured Motorists BI
* Underinsured Motorists PD
* Uninsured Motorists PD
* Other Indemnity
* Permanent Disability
* Temporary Disability
* Vocational Rehab - Evaluation
* Vocational Rehab - Indemnity
* Vocational Rehab - Training
* Employers Liability
* Retired - WC Indemnity Misc
* Medical
* Retired - WC Medical Misc
Indemnity BI
Indemnity PD
Expenses Adjusting
Expenses Legal
Expenses Other
Business Personal Property
Building 1
Medical Payments
SML - Clubs 5000-020
Collections / Recovery
Towing
Appraisal Fee
Administrative Fees
Diminished Value
Deductible
Expense Coverage
Coverage C
* Legal Expense
* Non-Legal Expense
* Expense
* Building
* Contents
* Other Property
* Extra Expense
* Inland Marine - All Other Scheduled Items
* Inland Marine - Contents Off Premises
* Inland Marine - Contents On Premises
* Income Loss
* Other Liability
* Bodily Injury
* Non-Vehicle Damage
* Vehicle Damage
* Claim
* No-Fault Basic
* No-Fault Excess
* No-Fault NY Optional
* Loss of Use
* Uninsured Motorists BI
* Underinsured Motorists BI
* Underinsured Motorists PD
* Uninsured Motorists PD
* Other Indemnity
* Permanent Disability
* Temporary Disability
* Vocational Rehab - Evaluation
* Vocational Rehab - Indemnity
* Vocational Rehab - Training
* Employers Liability
* Retired - WC Indemnity Misc
* Medical
* Retired - WC Medical Misc
Indemnity BI
Indemnity PD
Expenses Adjusting
Expenses Legal
Expenses Other
Business Personal Property
Building 1
Medical Payments
SML - Clubs 5000-020
Collections / Recovery
Towing
Appraisal Fee
Administrative Fees
Diminished Value
Deductible
Expense Coverage
Coverage D
* Legal Expense
* Non-Legal Expense
* Expense
* Building
* Contents
* Other Property
* Extra Expense
* Inland Marine - All Other Scheduled Items
* Inland Marine - Contents Off Premises
* Inland Marine - Contents On Premises
* Income Loss
* Other Liability
* Bodily Injury
* Non-Vehicle Damage
* Vehicle Damage
* Claim
* No-Fault Basic
* No-Fault Excess
* No-Fault NY Optional
* Loss of Use
* Uninsured Motorists BI
* Underinsured Motorists BI
* Underinsured Motorists PD
* Uninsured Motorists PD
* Other Indemnity
* Permanent Disability
* Temporary Disability
* Vocational Rehab - Evaluation
* Vocational Rehab - Indemnity
* Vocational Rehab - Training
* Employers Liability
* Retired - WC Indemnity Misc
* Medical
* Retired - WC Medical Misc
Indemnity BI
Indemnity PD
Expenses Adjusting
Expenses Legal
Expenses Other
Business Personal Property
Building 1
Medical Payments
SML - Clubs 5000-020
Collections / Recovery
Towing
Appraisal Fee
Administrative Fees
Diminished Value
Deductible
Expense Coverage
Endorsements:
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