NCSBI Fire and Arson Investigation Unit
Insurance Notification

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Fields marked with an asterisk (*) are mandatory

* Insurance Company Name:    
Claim Number:  
* Point of Contact:    
* Phone:    
* Email:    
* Date of Incident:    
* Address of Incident:    
* City:    
* County:    
* Owner of Property:    
Occupant of Property (if different from Owner):  
* Summary of Findings:    
* Has any agency filed an Insurance Immunity Letter with your agency regarding this incident?
  
If yes, which one?: