Claims – Assertive Home Warranty

Full Name

Property Address

Best Contact Email

Best Contact Phone

Approx. Age of Item

Date First Noticed

Description of Issue

Photo/Video Upload

1. CONTACT DETAILS

Full Name*

Property Address*

Email Address*

Best Contact Number*

2. CLAIM INFORMATION

Affected Item*

Item Age*

Date First Noticed*

Description of Failure*

3. Documentation & Verification

Make & Model

Serial Number

SUGGESTED: UPLOAD PHOTOS OF THE UNIT & SERIAL TAG TO SPEED UP DISPATCH!

MAX FILE SIZE: 10MB. MULTIPLE FILES ALLOWED.