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Forms & Receipt Confirmations

Use this page to complete receipt confirmations and a flood field questionnaire. This public site does not collect, store, submit, or email your answers. After completing the form, print it or choose “Save as PDF,” then send it to your assigned adjuster as requested.

Important: A typed or drawn signature on this public page is only a convenience for creating a printable acknowledgement packet. For formal e-signature workflows, your adjuster or Carrier may still require Adobe Sign, DocuSign, wet signature, or another approved method.

Open NFIP Flood Claims Handbook ↗ Open ICC Brochure ↗

FloodPath Receipt Confirmation & Field Questionnaire

Claim / Contact Information

Named Insured

Co-Insured / Entity Name, if applicable

Claim Number

Policy Number

Date of Loss

Date Completed

Best Phone Number

Email Address

Loss Address

Mailing Address, if different

Receipt Confirmation

Please confirm the materials you accessed or received. These confirmations only acknowledge receipt/access to the documents and do not determine coverage.

I acknowledge access to or receipt of the NFIP Flood Claims Handbook, which provides general information about the NFIP claims process. I acknowledge access to or receipt of the Increased Cost of Compliance (ICC) brochure, which provides general information about ICC coverage and the role of local floodplain/community officials. I understand that these materials are general references only and that final claim decisions are made only by the Carrier.

Flood Field Questionnaire

Occupancy / Use

Affected Area / Foundation Type

When did floodwater first affect the property?

Apparent source/path of flooding

Approx. exterior floodwater height

Approx. interior floodwater height

Rooms / areas affected

Cleanup / demolition status

Mitigation / drying company, if any

Contents damaged?

Mortgage on building?

I have taken or will take photos of flood-damaged building materials before removal/disposal. I have taken or will take photos of damaged contents before disposal. I will keep invoices, estimates, receipts, drying logs, and contractor documentation available for review. I understand that contractor/mitigation invoices should be itemized and tied to flood-related work.

Prior flood loss, prior repairs, or pre-existing damage known?

Other notes for the adjuster

Signature

By signing below, I confirm that the information provided above is accurate to the best of my knowledge and that I have acknowledged the receipt/access confirmations selected above.

Typed Signature / Printed Name

Signature Date

Draw Signature

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Privacy / Submission Note

This page runs in your browser. It does not upload, store, email, or submit the information you enter. After printing or saving the completed packet as a PDF, send it to your assigned adjuster only as instructed.

Coverage Disclaimer

FloodPath provides general claim communication and documentation guidance only. Field adjusters cannot approve/deny coverage or authorize payment. Final claim decisions are made only by the Carrier.

FloodPath Field Questionnaires

Use the residential questionnaire for dwelling/private residential claims. Use the commercial questionnaire separately for commercial / General Property claims. The adjuster addendum is internal only.

Open Residential Questionnaire Open Commercial Questionnaire Open Adjuster Addendum