::JBAIA NEW ASSIGNMENT:: New Assignment * - required field(s) Date Assigned: Client/Adjuster: * Client's email: Client's Phone: Client's Claim Number: Coverage Information Coverage Amounts: A. B. C. D. Other Deductible: Forms/Endorsement(s): Policy Number: Effective Date:(mm/dd/yyyy) Insured Name: Contact: Address: Phone: Claimant Name: Contact: Address: Phone: Loss Information Date of Loss:(mm/dd/yyyy) Location of Loss: Type of Loss: Description of Loss: Instructions: Attach File:(max file size: 5MB)