Lease Gap Insurance Claim
Lease GAP Insurance Claim
Policyholder Information
|
Name |
[Your Name] |
|---|---|
|
Address |
123 Elm Street, Springfield, IL, 62701 |
|
Contact Number |
(555) 123-4567 |
|
|
[Your Email] |
|
Policy Number |
GAP123456789 |
Vehicle Information
|
Make |
Toyota |
|---|---|
|
Model |
Camry |
|
Year |
2050 |
|
VIN |
1HGCM82633A123456 |
|
Leasing Company |
AutoLease Inc. |
Accident Details
Date of Accident: September 15, 2053
Location of Accident: 456 Oak Street, Springfield, IL, 62701
Description of Accident: The insured vehicle was involved in a rear-end collision, resulting in total loss. The accident occurred at an intersection when another vehicle failed to stop at a red light.
Claim Details
The net settlement amount paid by the auto insurance company for the total loss of the vehicle is $20,000.
Outstanding Lease Balance
|
Principal Balance |
$25,000 |
|---|---|
|
Early Termination Fees |
$500 |
|
Other Charges |
$300 |
|
Total Outstanding Balance |
$25,800 |
Claim Calculation
-
Total Outstanding Balance: $25,800
-
Net Settlement Amount: $20,000
-
Gap Amount: $5,800
The provided details confirm that the policyholder is entitled to a gap settlement of $5,800. This settlement will cover the difference between the insurance settlement and the outstanding lease balance.
Supporting Documents
-
Copy of Auto Insurance Settlement Statement
-
Lease Agreement
-
Accident Report
-
Repair Estimate
Declaration and Signature
I declare that the information provided in this claim is accurate and complete to the best of my knowledge. I understand that we calculated the gap settlement amount of $5,800 to cover the difference between the insurance settlement and the outstanding lease balance. I authorize the release of any necessary information to process this claim and agree to adhere to the terms and conditions outlined in my policy.
[Your Name]
[Date]
