Schedule A Ladder Assist

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Carrier*

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Type insured last name

Claim Number*

Type insured last name

Insured Last Name*

Address*

Address1

Address 2

City

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Service Type*

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LADDER ASSIST - Adjuster and Technician meet on site at specified time to perform inspection.

DIRECT INSPECTION - No Adjuster present, Hancock sets appointment with Insured and provides inspection information within 48 hrs. ** Insured contact information required**

TARP REMOVE & RESET - Technician removes and resets existing tarp to complete inspection.

EMERGENCY TARP - Technician installs emergency tarp, Hancock sets appointment with insured and installs within 48hrs ** Insured information required **

LADDER ASSIST WITH REPORT - Adjuster and Technician meet on site at specified time to perform inspection. Technician provides written report to adjuster within 48hrs of inspection. Additional upcharge does apply.

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CATASTROPHE EVENT*

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Is this claim due to a catastrophe weather event?

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Yes

Unknown

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RE-INSPECT

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Is this claim a re-inspect?

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