Utilities Insurance Claim
Utilities Insurance Claim
I. Policyholder Information
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Policyholder Name: |
[Your Name] |
|
Policy Number: |
123456789 |
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Contact Information: |
[Your Email], (555) 123-4567 |
|
Address: |
123 Elm Street, Springfield, IL 62701 |
II. Incident Description
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Date of Incident: July 25, 2054
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Type of Utility Service Affected: Electricity
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Duration of Service Disruption: 8 hours
Description of Incident:
On July 25, 2054, a severe thunderstorm caused a power outage in the Springfield area. The electricity supply was disrupted due to damage to the local power lines. The outage lasted for approximately 8 hours, during which time several electrical appliances in my home were damaged due to a power surge when the electricity was restored.
III. Damage Report
|
Item/Property Damaged |
Description of Damage |
Estimated Repair/Replacement Cost |
|---|---|---|
|
Refrigerator |
Electrical components damaged |
$800 |
|
Television |
Screen and circuit board damaged |
$600 |
|
Computer |
Power supply and hard drive failure |
$1,200 |
IV. Support Documentation
Attached Documents:
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Utility Bill showing service disruption
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Photographs of damaged property
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Repair estimates or invoices
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Any relevant correspondence with utility companies
V. Claim Statement
I hereby attest that all the information provided in this claim is accurate and comprehensive to the best of my knowledge. I request the insurance company to review my claim and provide the appropriate compensation for the losses incurred due to the utility service disruption.
VI. Signature
[Your Name]
[Date Signed]
