Firearm Loss Insurance Claim
Firearm Loss Insurance Claim
Claimant Information
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Claimant Name: |
Emily Smith |
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Contact Number: |
(555) 123-4567 |
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Address: |
123 Elm Street, Springfield, IL 62701 |
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Policy Number: |
POL123456789 |
Details of the Incident
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Date of Incident: |
September 25, 2052 |
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Type of Incident: |
Theft |
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Location of Incident: |
123 Main Street, Springfield, USA |
Description of Incident:
On September 25, 2050, at approximately 2:00 PM, my residence experienced an unauthorized entry, during which an individual or individuals broke into my home. As a result of this breach, my firearm, which had been securely stored in a locked cabinet, was unfortunately stolen.
Details of the Firearm
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Make and Model: |
Glock 19 |
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Serial Number: |
ABC123456 |
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Value: |
$600 |
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Date of Purchase: |
June 15, 2050 |
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Place of Purchase: |
Gun Store, Springfield, USA |
Supporting Documentation
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Police Report: A copy of the official police report, identified by Report No: 789456, details the incident and confirms the theft of the firearm.
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Photographs: High-resolution images of the damaged lock and the burglary scene, illustrating evidence of forced entry and the extent of the break-in.
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Receipt: The initial purchase receipt for the Glock 19, which includes the date, location, and amount paid, acts as evidence of ownership and the firearm's worth.
Claim Amount
Total Claimed: $600
Declaration
I at this moment declare that the information provided in this claim is true and accurate to the best of my knowledge. I understand that any false or misleading information submitted in this claim may result in the denial of my claim and possible legal action.
[YOUR NAME]
[DATE]
