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Forms

The following documents are provided as Portable Document Format (PDF) files. Adobe Acrobat Reader is required to view PDF files and is available free from the Adobe Web site.

Crime/Fidelity (Employee Theft) Notice of Loss Form
To be used to report theft of Money & Securities, Employee Theft of Agency Funds or other Monetary items such as Purchasing Card thefts.
(PDF, 61kb)

Lightning Affidavit
Proof of all reported Lightning claims must be accompanied by the Lightning Affidavit. The Affidavit must be completed by a Licensed Electrician. DOAS reserves the right to refuse signatures of facility maintenance staff that signs and submits this form.
(PDF,12KB)

Notice of Loss
To be used to report Building/Contents, All Risk, Crime/Employee Dishonesty, Aviation or Watercraft losses. You may fax the Notice of Loss Form to 404-656-2900. ALL losses should get reported to DOAS Risk Management ASAP.
(PDF,6KB)

Sworn Proof of Loss
Include with this form: copies of invoices, bills for material and labor, and evidence of payment (check or approved purchase order) for replaced or repaired items. ALL required documentation must be provided to finalize a claim with in 120 days from Date of Loss.
(PDF,7KB)