Home Insurance Claim Record
The policy, claim and loss adjuster details in one place, ready to quote.
Safety, records and practical forms · SF-496 · Log
Free printable photo and evidence log for a damage claim — numbered pictures, what each shows, the file name, where it is stored and what was sent. PDF.
2 pages. The A4 and US Letter files are laid out identically, so neither is shrunk to fit.
Print it and write on it
Fillable PDF type and save
Or no download needed
Fill it in onlineThe fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
The same sheet, on screen. Tick, type, add or remove rows, then print it or download the completed version as a PDF. Everything stays in your browser — your entries are kept in this browser's own storage on this device, nothing is uploaded, and there is no account.
A numbered index of the photographs and papers gathered after damage. Each picture gets a number, a date, a room, a line saying what it shows and the file name it was saved under, so a folder of two hundred images becomes something an insurer or a surveyor can follow.
Anyone making a claim after a leak, fire, flood or break-in, landlords photographing a property between tenancies, and people gathering evidence for a dispute with a builder, a neighbour or an agent.
The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.
Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.
Because a claim is discussed in writing weeks later, and 'the third picture of the kitchen' means nothing to anybody. A number on the page that matches a number in the folder lets you and the insurer point at the same image.
That is a question for your insurer, who may say something specific about it when you report the damage. This sheet records what you photographed and when, whenever that was.
The name the file is actually saved under, however unhelpful — IMG_4821 is fine. The point is that the picture can be found from the sheet, so copy it exactly.
No. It is an index of what you hold and what you sent. What is accepted as evidence depends on your policy, your insurer and the rules where you are.
You can, though the move-in and move-out inventories are built for that. This sheet suits the situation where damage has already happened and a claim or dispute is under way.
The policy, claim and loss adjuster details in one place, ready to quote.
Which photographs exist and what each one shows.
Which documents, references and numbers are written down and where.
Every damaged item, room by room, with an estimate against each.
Printable sheets, workbooks and tools on the same subject.
List what you own before you need to, so a claim or a police report starts from a document rather than from trying to remember a burgled room.
Room-by-room contents with what each thing cost and what it would cost to replace, totalled per room and overall — the list an insurer asks for.
Every sheet, binder, game and puzzle on Upkeep Papers is free to download, with no email and no account. Making them is not free: each one takes days of research, design and checking, and the site costs money to run. If something here saved you time, you can buy us a coffee. It is entirely optional: nothing is locked, and nothing changes if you don’t.
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