Get Auto Insurance Blank Claim Form
Ity Claim Instructions 1. To ensure your claim gets processed efficiently, please check the appropriate box for the coverage you are filing a claim under. If both, please check both boxes. Accident Hospital Indemnity 2. Please complete the claim form below in its entirety (if information is missing, it may delay the processing of your claim). 3. Be sure to sign and date the authorization and claim form. 4. Provide the date and description of your accident or onset of illness. 5. Please provide P.
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