Get Unitron Loss And Damage Form

Filing a loss and damage claim for your hearing instrument can be a straightforward process. This guide provides clear instructions to help you complete the Unitron Loss And Damage Form online efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Unitron Loss And Damage Form. This will open the form in an editor for your convenience.
2. Begin by filling in the claimant's information. Enter your full name in the designated field, followed by the date of occurrence of the loss or damage.
3. Next, provide details about your hearing aid. Enter the model name and the serial number(s) of your device.
4. Indicate the type of receiver used by selecting either 'Standard' or 'Power'. Then, specify the side of the receiver by selecting 'Left' or 'Right'.
5. If applicable, fill out the receiver length option by choosing '0', '1', '2', or '3'. For RIC (Receiver in Canal) only, select the cShell type and material accordingly.
6. Provide a detailed description of how the hearing instrument was lost or damaged, ensuring you explain the circumstances clearly.
7. Fill in the dispenser's information, including the dispenser’s name, account number, address, city, state, phone number, zip code, and fax number.
8. Review the certification statement asserting that the provided information is correct. You will need to sign this statement in the presence of a notary.
9. Once completed, save your changes to ensure all your entries are captured. You have the option to download, print, or share the filled form as needed.
10. Finally, return the completed form to Unitron Customer Service via fax at 800.894.9997.

Complete your Unitron Loss And Damage Form online today for a smooth claims process.