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Sample Claim and Proof of Loss Forms

The following are samples of claim and proof of loss forms. You can use them for "dwelling" and "contents" claims. Please refer to our Dwelling Tips, Claim Tips, the Disaster Recovery Handbook, and other United Policyholders' publications for guidance on documenting loss and damage fully and getting fairly, promptly paid on claims.

Sample Letters:

 Sample Letter Requesting Copy of Policy
 
Sample Letter Requesting Information About Insurance Benefits for Temporary Living Expenses ("ALE/Loss of Use")
 Sample Letter Asking for the Waiver of the Contents Itemization Requirement
 
Sample Letter Asking for a Personal Property Claim Settlement
 
Sample Letter Requesting Payment History
 Sample Letter Protecting Your Legal Rights
 Sample Letter Requesting Extensions of Policy Deadlines
 Sample Letter Requesting Information About Claim Denial

 


Sample Claim Forms:

 Sworn Statement In Proof of Loss

Dwelling repairs/rebuilding/Scope of Loss 
 Debris Removal
 Dwelling Scope of Loss
 Code Upgrades
 Other Stuctures
 Rebuilding Estimate
 Trade Summary Breakdown

Contents/Personal Property
 Inventory/Personal Property Claim Worksheets (Excel doc) - United Policyholders Home Inventory Worksheets for you to complete and save on your computer or recovery flash drive

 Example of a completed home inventory - 2003 Cedar Fire Survivor and Disaster Recovery Mentor, Julie Robinson, has donated her contents claim form to United Policyholders 


Depreciation:

Consumer-oriented Guides
 Depreciation Info for Personal Property Items
 Depreciation Schedule - Residential Personal Property 

Industry Guides
 Depreciation Guide by "Claims Pages" - an insurance industry resource website. Look under "Tools" at www.claimspages.com to find this and other tools for calculating losses and costs to replace/repair.
 Example of Insurance Company Depreciation Guide


Sample Damage Reports:

Mold and Asbestos Report
Air Quality/Industrial Hygienist Report
Engineering
Fire Cause and Origin
Seismic