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.
Dwelling
Scope of Loss
Dwelling Scope of Loss (pdf 3MB)
Code Upgrades (pdf 1MB)
Other Stuctures (pdf 568K)
Rebuilding Estimate (pdf 532K)
Trade Summary Breakdown (pdf 16K)
Sworn Statement In Proof of Loss
Contents/Personal Property
Inventory/Personal Property Claim Worksheets (Excel doc) - Complete and save on the computer Inventory/Personal Property Claim Worksheets (pdf) - Print out and complete by hand United Policyholders offers free worksheets that you can use to complete and submit a personal property/contents claim to your insurance company. We offer them in two different formats (Excel and PDF). If you want to prepare your inventory on a computer, use the Excel version, input info and save it on your computer. If you want to prepare it by hand, manually as you remember things - print out the PDF version and use that. These worksheets were donated to United Policyholders by Mike Kirby, a contents claim professional. He uses this list to help his clients get their contents claims processed and paid.
2003 Cedar Fire Survivor’s contents claim form (Excel doc)
- 2003 Cedar Fire Survivor and Disaster Recovery Mentor, Julie Robinson, has donated her contents claim form to United Policyholders Sample Property Inventory (pdf 3.7MB)
Depreciation Info for Personal Property Items (pdf)
Depreciation Guide by "Claims Pages" (pdf)
- 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.
United Policyholders is a non-profit organization founded in 1991 and dedicated to educating the public on insurance issues and consumer rights. UP publishes educational materials and serves as a resource for individual and business policyholders and residents of communities with insurance problems. UP’s Amicus Project provides information to courts of law to support policyholders’ legal rights. UP unites policyholders and their advocates by sharing information. Write to UP at 110 Pacific Ave., PMB 262, San Francisco, CA. 94111, call us at (510) 763-9740, or visit our website at www.unitedpolicyholders.org.
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