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
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.
[YOUR NAME]
[DATE]
Claim Templates @ Template.net
