Claims « Professional Liability for NC Public School Personnel

Claims

Please use the form below to process a claim:
This policy was incepted in 2011. For any claim prior to 2011 please contact your local LEA

Type of Coverage:
If other above, please describe:
Date of Occurrence*

MM

DD

YYYY

(IE: Date of alleged criminal act or date of alleged wrongful act)
Full Name*

First

Last
Title
Work Phone Number*
Personal Phone Number*
Home Address*

Street Address

Address Line 2

City

State

ZIP Code
Email*
Claimant Name

First

Last
Please provide a brief description of the circumstances surrounding the loss or claim being reported:*
If party reporting claim is not the “claimant” please state relationship:

(ie spouse, relative, etc.)
Attach any relevant files
Max. file size: 64 MB.
Please prove you are human by selecting the Heart.

Questions regarding assistance with a claim please email: