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APPLICATION FOR LAWYERS PROFESSIONAL LIABILITY INSURANCE CNA RENEWAL SUBMISSION: CLAIM AND POTENTIAL CLAIM SUPPLEMENT NOTE: Complete this supplement for the Underwriting File if a claim×potential

How to fill out renewalclaimsupp 3 14

How to fill out renewalclaimsupp 3 14:

Start by entering your personal information:

1. Provide your full name, address, and contact details.
2. Include your date of birth and social security number.

Fill in the policy information:

1. Enter the policy number and the effective date of the policy.
2. Specify the type of policy or coverage you are renewing.

Provide details about the claim:

1. Explain the reason for the claim and provide any relevant supporting documentation.
2. Include the date of the incident or occurrence related to the claim.

Describe the damages or injuries:

1. Provide a detailed description of the damages or injuries incurred.
2. Include any estimates or medical reports that support your claim.

Indicate any witnesses or involved parties:

1. If there were any witnesses to the incident, provide their names and contact information.
2. If there were any other involved parties, such as drivers in a car accident, provide their details as well.

Review and sign the form:

1. Carefully review all the information you have entered to ensure accuracy.
2. Sign and date the form to certify that the information provided is true and complete.

Who needs renewalclaimsupp 3 14:

1. Those who have an existing insurance policy and need to renew it.
2. Individuals who have experienced damages or injuries covered by their insurance policy and need to file a claim.
3. People who have witnessed an incident and need to provide information or support for a claim.

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