Get Az C-tpc Third-party Consent 2017

The AZ C-TPC Third-Party Consent form allows an insured person or claimant to authorize a representative to file a complaint on their behalf with the Arizona Department of Insurance. This guide provides clear, step-by-step instructions for completing the form online.

Follow the steps to accurately fill out the AZ C-TPC Third-Party Consent form

1. Click ‘Get Form’ button to access the AZ C-TPC Third-Party Consent form and open it for editing.
2. Provide your printed name in the designated field for 'Insured or Claimant' to identify yourself.
3. Sign the form in the 'Signature' section to confirm your consent for the authorized person to act on your behalf.
4. Enter the date of signing in the 'Date' field to ensure the consent is valid and reflects when it was granted.
5. Fill in your street address, city, state, zip code, email address, and phone number in the respective fields to provide complete contact information.
6. In the section for the complaint, specify the insurance company or insurance producer/adjuster involved along with a brief summary of the reason for your complaint.
7. Under 'Authorized Person,' enter the printed name of the individual who will act on your behalf.
8. Have the authorized person sign the form in the 'Signature' section to validate their involvement.
9. Ensure the authorized person dates the form in the 'Date' field, providing a clear timeline for their consent.
10. Complete the authorized person’s contact information, including their street address, city, state, zip code, email, and phone number.
11. Review all filled sections for completeness and accuracy, then save changes, download the completed form, print it, or share it as needed.

Complete your documents online for a seamless experience.