Franchise Insurance Claim
Franchise Insurance Claim
I. Claimant Information
|
Name: |
[Your Name] |
|
Role: |
Franchisee |
|
Contact Number: |
(123) 456-7890 |
|
Email Address: |
[Your Email] |
|
Mailing Address: |
123 Main Street, City, State, ZIP |
II. Policy Information
|
Policy Number: |
INS123456789 |
|
Insured Entity: |
Elite Franchise Group Ltd. |
|
Effective Date: |
January 1, 2053 |
|
Expiration Date: |
December 31, 2053 |
III. Incident Description
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Date of Incident: October 1, 2053
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Location of Incident: 123 Franchise Blvd, City, State, ZIP
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Description of Incident: A severe storm caused extensive damage to the storefront property, resulting in broken windows, roof damage, and flooding. Additionally, a business interruption occurred due to the temporary closure needed for repairs.
IV. Damage or Loss Details
|
Type of Loss |
Description |
Estimated Cost |
|---|---|---|
|
Property Damage |
Broken windows, roof damage, flooding |
$15,000 |
|
Business Interruption |
Loss of income during repairs |
$10,000 |
|
Liability Claims |
Potential claims from customers due to the incident |
$5,000 |
V. Supporting Documents
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Photos of the Damage: Clear, high-resolution images of broken windows, roof damage, and flooding.
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Repair Estimates: Detailed estimates from contractors for repairs and flood remediation, including labor and materials.
-
Financial Statements: Income statements and profit reports showing revenue loss during the business interruption.
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Previous Liability Claims: Documentation of any prior claims related to similar incidents.
VI. Claim Amount
|
Type of Claim |
Description |
Amount Requested |
|---|---|---|
|
Property Damage |
Includes repair costs for broken windows, roof damage, and flood remediation. |
$15,000 |
|
Business Interruption |
Compensation for lost income during the repair period, based on documented revenue loss. |
$10,000 |
|
Liability Claims |
Estimated amount to cover potential claims from customers affected by the incident. |
$5,000 |
|
Total Claim Amount |
$30,000 |
VII. Signature
[Your Name]
[Date Signed]
