School Pool for Excess Liability Limits

Joint Insurance Fund

Crime Claim Loss Form

Please complete the form below to report a Crime Claim Loss in your district.

Please indicate type of claim:
- Incident Report Only
- Making a Claim
JIF:
- ACCASBO
- BCIP
- GCSSD
Member District*
Address with City, State & Zip*
Contact Name:*
Contact Person's Telephone Number:*
Contact Person's Email:
Date of Incident:
Date Reported:
Incident Description:
Incident Discovered By Whom:
By What Means:
Approximate Duration of Incident:
Suspect(s) if known, and Date(s) of Employment and/or Department:
Investigating Law Enforcement Agency and/or Jurisdiction:
Charges Filed?
Other(s) Involved:
Additional Information:
Comments
This field is for validation purposes and should be left unchanged.

Powered by : Big Boom Design : Blog