Get the free POLICYHOLDERS STATEMENT

Mail completed form and attachments to: HM Life Insurance Company P.O. Box 535050 Pittsburgh, PA 15253-5050 888-529-8983 www.hminsurancegroup.com or Fax to: 800-749-9826 HM Worksite Advantage Disability

How to fill out policyholders statement

How to fill out a policyholder's statement:

1. Start by gathering all the necessary information. This may include the policy number, the insured's personal details, details of the incident or claim, and any supporting documentation.
2. Begin by filling out the personal details section of the statement. Include the insured's full name, contact information, and any other relevant personal information.
3. Move on to the policy details section. Fill in the policy number, the type of policy, and any other relevant policy information. This section helps provide context for the claim or incident being reported.
4. Provide a detailed description of the incident or claim. This should include where and when it occurred, a thorough explanation of what happened, and any other pertinent details. Be as specific and accurate as possible when filling out this section.
5. If there were any witnesses to the incident, include their names, contact information, and a brief description of their account of the incident. Witness statements can help corroborate the insured's version of events.
6. Attach any supporting documentation to the statement. This may include photos, videos, police reports, medical reports, or any other relevant evidence. Make sure to label each document clearly and attach them securely to the statement.
7. Review the completed statement for accuracy and completeness. Double-check all the provided information to ensure it is correct. If there are any mistakes or missing information, make the necessary corrections.

Who needs a policyholder's statement?

1. Insurance companies typically require policyholders to submit a statement when filing a claim. The statement helps the insurance company understand the details of the incident or claim and assists them in processing the claim.
2. When involved in an accident or incident covered by insurance, policyholders may need to provide a statement to law enforcement or other relevant authorities. This statement can help document the incident and provide important information for ongoing investigations.
3. Individuals involved in legal proceedings related to an insurance claim may also need to provide a policyholder's statement. This statement can serve as evidence in court and help establish the facts of the case.
4. In some instances, third parties involved in an incident may be required to provide a statement as well. For example, if a policyholder's property is damaged by someone else, the responsible party may need to submit a statement explaining their involvement in the incident.

Remember, it is essential to follow any specific guidelines or instructions provided by your insurance company when filling out a policyholder's statement.

For pdfFiller’s FAQs

What is policyholders statement?

Policyholders statement is a document where policyholders provide information about their insurance coverage, claims, and other relevant details.

Who is required to file policyholders statement?

Policyholders are required to file policyholders statement.

How to fill out policyholders statement?

Policyholders can fill out the statement by providing accurate information regarding their insurance coverage, claims, and other requested details.

What is the purpose of policyholders statement?

The purpose of policyholders statement is to ensure that insurance companies have up-to-date information about their policyholders and their coverage.

What information must be reported on policyholders statement?

Policyholders must report information about their insurance coverage, claims, and any changes to their policy.

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