Hurricane and Natural
Disaster Claim Form
To be completed by the Insured / Guest
Name of Insured / Guest Reservation #
Address Work Phone # Home Phone #
E-mail Address Date of Birth
Scheduled Departure Date Scheduled Return Date Date of Incident (mm/dd/yy)
Property Management Company Date Cancelled, Interrupted, Delayed (mm/dd/yy)
Name of leaseholder on the rental property and list all guests occupying the property
Please briey explain the circumstances of your claim:
Please check the box which applies to your claim
Additional accommodation and meal expenses
Amount being claimed: ___________________
Additional Transportation Expenses
Amount being claimed: ___________________
Prepaid, Unused non-refundable property rental costs
Amount being claimed: ___________________
Please supply the following items based on which box you’ve checked.
3 Please submit the proof of payment (credit card statement or cashed check) for insurance purchase and claimed expenses.
Please complete and submit the completed form along with verification of your claimed expenses:
• For additional Accommodation Expenses:
￮ Please provide us with proof of payment for additional accommodations and meal expenses (invoices or receipts and a copy
of your canceled check or credit card statement showing payment for the additional expenses).
• For additional Transportation Expenses:
￮ Please provide us with proof of payment for additional transportation expenses (invoices or receipts and a copy of cancelled
checks or credit card statement showing payment for the additional expenses).
Signature Date
Authorized Representative Date
Arch-2018
Claims Department:
Red Sky Claims, C/O Arch Insurance Company
Executive Plaza IV, 11350 McCormick Road, Suite 102, Hunt Valley, MD 21031
Toll Free Phone: (866) 889-7409 | Fax: (443) 279-2901
E-mail: Redsky@Archinsurance.com
Any person who knowingly presents a false or fraudulent claim for payment of loss or benet or
knowingly presents false information in an application for insurance is guilty of a crime and may be
subject to nes and connement in prison.
