Firearm Loss Insurance Claim

Claimant Information

Claimant Name:	Emily Smith
Contact Number:	(555) 123-4567
Address:	123 Elm Street, Springfield, IL 62701
Policy Number:	POL123456789

Details of the Incident

Date of Incident:	September 25, 2052
Type of Incident:	Theft
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

Make and Model:	Glock 19
Serial Number:	ABC123456
Value:	$600
Date of Purchase:	June 15, 2050
Place of Purchase:	Gun Store, Springfield, USA

Supporting Documentation

Police Report: A copy of the official police report, identified by Report No: 789456, details the incident and confirms the theft of the firearm.

Photographs: High-resolution images of the damaged lock and the burglary scene, illustrating evidence of forced entry and the extent of the break-in.

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.