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Affidavit of Inspection for Risk Management Division 85 State House Station Augusta, ME 04333 18005251252 PAGE 1 PLEASE PRINT OR TYPE EQUIPMENT OWNED BY OWNERS INFORMATION CONTACT PERSON TELEPHONE
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How to fill out electrical loss form doc
How to fill out electrical loss form doc:
01
Begin by writing your name and contact information in the designated fields at the top of the form. Include your full name, address, phone number, and email address.
02
Next, provide the date of the incident in question. This could be the date when the electrical loss or damage occurred.
03
Describe the details of the electrical loss or damage. Include specific information such as the location where it occurred, the equipment or appliances affected, and any relevant circumstances surrounding the incident.
04
Indicate whether there were any individuals injured as a result of the electrical loss. If there were injuries, provide the names and contact information of the affected individuals.
05
If you have any supporting documents or evidence related to the electrical loss, such as photographs or repair receipts, attach them to the form. Clearly label and describe each piece of evidence.
06
Provide a brief summary of the actions you have taken to address the electrical loss or damage. This may include contacting an electrician, filing an insurance claim, or seeking reimbursement for expenses incurred.
07
Finally, sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.
Who needs electrical loss form doc:
01
Homeowners who have experienced electrical loss or damage in their property.
02
Business owners or managers whose establishments have suffered electrical loss or damage.
03
Individuals or organizations seeking compensation or reimbursement for electrical loss from insurance companies or other responsible parties.
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