Property Subrogation Form

Please submit as much of the following information currently known for all subrogation matters (time is of the essence, thus partial information is acceptable):

Amica Subrogation Portal
Amica Representative
Amica Representative
First
Last

____________________________________

Type of Loss
Total Loss is approximately:

If there has been an expert assigned, please provide:

Expert Name
Expert Name
First
Last
Please send your confidential file materials in the customary way via SecureShare to: