The Asurion F-017-08 MEN form is a specific document designed to assist individuals in managing their insurance claims related to electronics and devices. This form streamlines the process, ensuring that all necessary information is captured accurately. Understanding its purpose and proper usage can greatly enhance your experience with insurance claims.
The Asurion F-017-08 MEN form plays a crucial role in the realm of consumer electronics insurance, particularly for those who have opted for protection plans offered by Asurion. This form serves as a key document for filing claims related to damaged or lost devices, ensuring that users have a clear pathway to receive compensation for their misfortunes. It encompasses essential information, including personal details of the policyholder, specifics about the device in question, and a detailed account of the incident leading to the claim. Additionally, the form requires the submission of supporting documentation, which may include receipts, photos, or police reports, depending on the nature of the claim. Understanding how to accurately complete this form is vital for a smooth claims process, as any inaccuracies or missing information could lead to delays or denials. By familiarizing oneself with the Asurion F-017-08 MEN form, policyholders can navigate the claims process with confidence, ensuring they receive the support they need when they need it most.
How to Submit the Required Documentation
&KRRVHDQRSWLRQ2QOLQHRU)D[DQGIROORZWKHVWHSV
DO NOT FAX THIS PAGE
2QOLQH5HFRPPHQGHG
11SJOU mMMPVUBOETJHOUIF4XPSO"GmEBWJU1SPPGPG-PTT4UBUFNFOU
)RXQGRQSDJHRIWKLVGRFXPHQW
4DBOPSUBLFQJDUVSFTPGCPUIUIFDPNQMFUFEBGmEBWJUBOEZPVSWBMJEQIPUP*%
$FFHSWDEOHIRUPVRISKRWR,'YDOLGGULYHU·VOLFHQVHSDVVSRUWIHGHUDOO\LVVXHG,'FDUGRUPDWULFXODFRQVXODU,'
36QMPBECPUIEPDVNFOUTBUQIPOFDMBJNDPNNFUSPVQMPBEFS
)D[
1IPUPDPQZZPVSWBMJEQIPUP*%BOEIBOEXSJUFZPVS$MBJN*%OVNCFSPOUIFQBQFS
3 'BYCPUIEPDVNFOUTUP
+RZWRSUHYHQWGHOD\VLQSURFHVVLQJ\RXUFODLP
7KHGRFXPHQWLVPDUNHGZLWKDEDUFRGHWKDWLVVSHFLÀFWR\RXUFODLP8VLQJDSKRWRFRS\ZLWKDQLQFRUUHFWEDUFRGHZLOOGHOD\\RXUFODLP 0DNHVXUH\RXKDYHDYDOLGSKRWR,'
•$FFHSWDEOHIRUPVRISKRWR,'YDOLGGULYHU·VOLFHQVHSDVVSRUWIHGHUDOO\LVVXHG,'FDUGRUPDWULFXODFRQVXODU,'
•8QDFFHSWDEOHIRUPVRI,'VWXGHQW,'ZRUN,'ELUWKFHUWLILFDWH, military ID, common access card,DQG6RFLDO6HFXULW\FDUG
•1DPHRQWKH,'PXVWPDWFKQDPHRIWKH0HWUR$FFRXQW2ZQHUZKRFRPSOHWHVWKH6ZRUQ$IÀGDYLW 3URRIRI/RVV6WDWHPHQW
•,IQDPHGRHVQRWPDWFKWKHQ\RXPD\QHHGWRSURYLGHDGGLWLRQDOGRFXPHQWDWLRQ
•7KH,'FDQQRWEHH[SLUHG,IWKH,'DSSHDUVDOWHUHGIRUJHGLOOHJLWLPDWHRUXQUHDGDEOHZHZLOOQRWEHDEOHWRSURFHHGZLWK\RXUFODLP
0DNHVXUHDOOGRFXPHQWVFDQVRUID[HVDUHFOHDUDQGHDV\WRUHDG
•:KHQPDNLQJWKHSKRWRFRS\RI\RXUSKRWR,'FRQVLGHUXVLQJWKHHQODUJHDQGFRQWUDVWVHWWLQJVWRPDNHWKH,'HDVLHUWRUHDG
•%ODFNDQGZKLWHFRSLHVDUHSUHIHUUHG
+RZWRÀQG\RXUGHYLFHPDQXIDFWXUHUPRGHODQG(610(,',0(,
)RUPRVWGHYLFHV
For Android products:
)RU$SSOHSURGXFWV
)LQGWKLVLQIRUPDWLRQRQ
•/RJLQWRJRRJOHFRPGDVKERDUG
•2SHQL7XQHV
• %DFNRIWKHSKRQHGHYLFHRUXQGHUWKHEDWWHU\
•&OLFNWKH$QGURLGVHFWLRQWRGLVSOD\
•&KRRVHL7XQHV!3UHIHUHQFHVLQ0DF26;
QRWDOOEDWWHULHVDUHDFFHVVLEOH
(610(,',0(,
•&KRRVH(GLW!3UHIHUHQFHVLQ:LQGRZV
•<RXU&XVWRPHU$JUHHPHQW
•&OLFNWKH'HYLFHVWDE
DYDLODEOHDWSKRQHFODLPFRPPHWUR
•3RVLWLRQWKHPRXVHRYHU´%DFNXS'HYLFHµ
•7KHER[WKHSKRQHGHYLFHFDPHLQWRGLVSOD\(610(,',0(,
•,IQRQHRIWKHVHLWHPVDUHDYDLODEOHSOHDVHFRQWDFW 0HWUR
9LVLWXVRQOLQHDWSKRQHFODLPFRPPHWURRUFDOO$VXULRQDWIRUTXHVWLRQVUHJDUGLQJWKHFODLPVSURFHVV
Sworn Affdavit & Proof of Loss Statement
5)*4%0$6.&/5.645#&$0.1-&5&%#:"/"$$06/508/&30/:063.&5308*3&-&44"$$06/5
5)&1&340/$0.1-&5*/(5)&%0$6.&/5.645"-401307*%&"1)050$01:0'5)&*37"-*%1)050*%
,1685$1&()5$8',6$&5,0(
)RU\RXUSURWHFWLRQDSHUVRQZKRNQRZLQJO\SUHVHQWVDIDOVHRUIUDXGXOHQWLQVXUDQFHFODLPZLWK WKHLQWHQWWRLQMXUHGHIUDXGRUGHFHLYHDQ\LQVXUHULVJXLOW\RIDFULPHDQGPD\EHVXEMHFWWR ÀQHVDQGFRQÀQHPHQWLQSULVRQ:KHQIUDXGLVGLVFRYHUHG$VXULRQWDNHVDSSURSULDWHVWHSVWR
VWRSVXFKIUDXGDQGH[SORUHVDOORILWVDYDLODEOHOHJDOUHPHGLHV
:KDWGHYLFHDUH\RXFODLPLQJ"$//),(/'6$5(5(48,5('3/($6(35,1786,1*%/8(25%/$&.,1.
Claim ID:
0DQXIDFWXUHU
&YBNQMFT4BNTVOH -( ;5& FUD
:LUHOHVV1XPEHU
0RGHO
&YBNQMFT(BMBYZ4 ' ;."9 FUD
3FGFSUPUIFJOTUSVDUJPOTPOUIFQSFWJPVTQBHF
:KDWKDSSHQHGWRWKHGHYLFH"
0\'HYLFH,V /RVW 6WROHQ 'DPDJHG 0DOIXQFWLRQLQJ
'DWHRI2FFXUUHQFH
3ODFHRI2FFXUUHQFH
'HVFULEH:KDW+DSSHQHG
$FFRXQW2ZQHULQIRUPDWLRQ
)XOO1DPH
3ULPDU\3KRQH
$OWHUQDWH3KRQH
Email Address:
%LOOLQJ$GGUHVV
&LW\
6WDWH
Zip Code:
&ODLPDJUHHPHQW
,KHUHE\PDNHDQLQVXUDQFHFODLPDJDLQVWWKHLQVXUDQFHFRPSDQ\DVVKRZQRQWKLVLQVXUDQFHFODLPDIÀGDYLW,DFNQRZOHGJHWKDWLIDQ\SURSHUW\ZKLFKLVWKHVXEMHFWRI WKLVFODLPDQGZKLFKLVUHSODFHGRUSDLGIRUE\WKHLQVXUHULVUHFRYHUHGDWDQ\WLPHLWLVWKHSURSHUW\RIWKHLQVXUDQFHFRPSDQ\DQGPXVWEHUHWXUQHGWRWKHLQVXUDQFH FRPSDQ\,XQGHUVWDQGWKDWLI,IDLOWRUHWXUQVXFKSURSHUW\,DPVXEMHFWWRDQGDXWKRUL]HDQRQUHWXUQIHHRIXSWRWREHFKDUJHGXQGHUWKHLQVXUDQFHSROLF\XVLQJ WKHPHWKRGRISD\PHQWXVHGWRRULJLQDOO\ÀOHWKLVFODLP
,VZHDUDIÀUPWKDWWKHGHYLFH,DPFODLPLQJLVRZQHGE\PHDQGWKDWWKHLQIRUPDWLRQSURYLGHGDERYHLVWUXHDQGDFFXUDWH,XQGHUVWDQGWKDWNQRZLQJO\SUHVHQWLQJ IDOVHRUIUDXGXOHQWLQIRUPDWLRQLQVXSSRUWRIWKLVLQVXUDQFHFODLPZLWKWKHLQWHQWWRLQMXUHGHIUDXGRUGHFHLYHDQ\LQVXUHULVDFULPH$VXULRQPD\WDNHOHJDO
DFWLRQLQFOXGLQJUHSRUWLQJWRODZHQIRUFHPHQWZKHQLWVXVSHFWVIUDXGLQWKHSUHVHQWDWLRQRILQVXUDQFHFODLPV
6LJQDWXUH
Date:
&RQWURO)0(15HYEDT5'7
Web: pKRQHFODLPFRPPHWURXSORDGHU )D[
$VXULRQ$WWQ5HYLHZ7HDP32%R[.DQVDV&LW\02
Complemento Carta Porte - Contains information on the shipping route and delivery deadlines.
Dd Form 2870 Release of Information - It is important for ensuring that healthcare providers have complete patient histories.
Filling out and utilizing the Asurion F-017-08 MEN form requires careful attention to detail. Here are some key takeaways to help you navigate the process effectively:
By keeping these takeaways in mind, you can navigate the Asurion F-017-08 MEN form with greater confidence and clarity.