Report a Loss Date of Loss: Date Form Completed: Reported to Fire Department? (required): YesNo Mortgage on property where loss occurred? (required): YesNo Other insurance covering this property? (required): YesNo I hereby certify that I have the authority to make this request by being insured or a representative of the insured.* Contact Us 322 4th StreetPO Box 207West Point, IA 52656-0207 (319) 837-6421[email protected]