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Sample Claim and Proof of Loss Forms

The following are samples of claim and proof of loss forms. You can use them for "dwelling" and "contents" claims. Please refer to our Dwelling Tips, Claim Tips, the Disaster Recovery Handbook, and other United Policyholders' publications for guidance on documenting loss and damage fully and getting fairly, promptly paid on claims.

Claim Forms:

 Sworn Statement In Proof of Loss

Sample Letters:

 Sample Letter Protecting Your Legal Rights
 Sample Letter Requesting Copy of Policy
 Sample Letter Requesting Information About Insurance Benefits for Temporary Living Expenses ("ALE" "Loss of Use")
 Sample Letter Requesting Payment History
 Sample Letter Asking for the Waiver of the Contents Itemization Requirement
 Sample Letter Requesting Extensions of Policy Deadlines

Depreciation Guides:
(also see "contents" section below)

Industry Guides: 
 Depreciation Guide by "Claims Pages" - an insurance industry resource website. Look under "Tools" at www.claimspages.com to find this and other tools for calculating losses and costs to replace/repair.

 Example of Insurance Company Depreciation Guide

Consumer-oriented Guides:
 Depreciation Info for Personal Property Items

 Depreciation Schedule - Residential Personal Property 

Dwelling repairs/rebuilding:

Coordinated Debris Removal

Scope of Loss
Dwelling Scope of Loss
Code Upgrades
Other Stuctures

Repair/Rebuilding Costs
  Rebuilding Estimate
  Trade Summary Breakdown

Reports:
 Hygenist and Air Quality Report
Engineering 
 Fire Cause and Origin
 Seismic

Contents/Personal Property:

United Policyholders Home Inventory Worksheets
Inventory/Personal Property Claim Worksheets (Excel doc) - Complete and save on the computer 

Example of completed home inventory
UP Home Inventory Worksheets (Excel doc) - Complete and save on the computer, then store offsite.
 - 2003 Cedar Fire Survivor and Disaster Recovery Mentor, Julie Robinson, has donated her contents claim form to United Policyholders