Aviation Adjusting Associates


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Aviation Adjusting Associates
416 Augusta Street
Elmore, OH 43416
V: 419-862-7328
F: 419-862-7421
 
OFA, Inc
OFA, Inc
 

Claims Form
Please complete our online claims form and we will respond back to you promptly.

Claim Details
DOL (MM/DD/YYYY):
Claim Number:
Policy Number:
Registration Number:
Aircraft/Marine Craft Information (Make, Model, Year):
Policy Dates:
Claim Type
Aircraft:
Marine:
Other:
Description of Loss:
Assignment Type:
General Assignment Instructions:
Limited Assignment
Full Assignment

Client Information
First Name: Last Name:
Client Company Name:
Address: City:
State: Zip Code:
Phone: Fax:
Email Address:


Insured Name & Contact Information
First Name:
 Middle:
 Last Name:
Company Name:
Address 1:
 Address 2:
City:
 State:
 Zip:
Phone#:
 Other Phone#:
 Fax#:
Other Information Insured Contact:


Claimant Information - Primary
First Name:
 Middle:
 Last Name:
Company Name:
Address 1:
 Address 2:
City:
 State:
 Zip:
Phone#:
 Other Phone#:
 Fax#:
Other Information Insured Contact:

Are there additional claimants or other parties involved?
Yes No

 

 
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