Get Notice To Applicant Of Dispute Between Insurers. Form Number 1255e - Fsco Gov On

Filling out the Notice To Applicant Of Dispute Between Insurers (Form Number 1255E) requires careful attention to detail. This guide provides clear instructions to support you in completing the form accurately and efficiently online.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the applicant. Fill in the last name, followed by the first name. Indicate the appropriate title: Mr., Mrs., or Ms.
3. Provide the street address, city, province, and postal code of the applicant. Make sure to enter the correct details for accurate communication.
4. Enter the date of the accident by filling in the day, month, and year in the specified fields.
5. In Part 1, indicate the insurer to whom you applied for accident benefits. Include the company name, mailing address, city, province, postal code, and the contact person's name and phone number.
6. In Part 2, list the insurer(s) notified to pay benefits. Repeat the process for each insurer, using additional sheets if necessary.
7. Complete Part 3 by providing the reasons for notifying other insurers about the dispute. Attach extra pages if you need more space.
8. In Part 4, the insurer representative must sign and date the form to validate it.
9. If you wish to object to the transfer of your claim, complete Part 5. Enter your name, date, and provide your signature.
10. Review all entered information for accuracy. Once complete, save the changes, and choose to download, print, or share the form as needed.

Start the process today by completing the necessary documents online.