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421 NW Riverside Drive, Evansville, IN 47708, 812-433-4000 Win/Loss Statement Request Form Win/Loss Statements will be available in January of each year for the prior year. Contact information is
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How to fill out win loss request form
How to fill out a win loss request form:
01
Start by obtaining a copy of the win loss request form from the relevant source, such as your insurance company or employer.
02
Carefully read the instructions provided on the form to understand the specific requirements and information needed.
03
Begin filling out the form by providing your personal information, including your name, contact details, and any identification numbers required.
04
Next, provide details about the specific win/loss event you are requesting for, including the date, location, and any other relevant information.
05
If there were any witnesses present during the event, provide their names and contact information, if requested.
06
Ensure that you accurately and thoroughly describe the circumstances of the win/loss event, including any relevant details or documents that support your claim.
07
Check if there are any additional sections or documents required to be attached to the form, such as police reports, medical records, or photographs. Make sure to attach these as instructed.
08
Review the completed form thoroughly to ensure all information is accurate and complete. Correct any errors, if necessary.
09
Depending on the instructions provided, submit the form via mail, email, fax, or in person. Make sure to keep a copy of the form for your records.
Who needs a win loss request form?
01
Individuals who have experienced a win or loss event and want to formally request an investigation or review.
02
Insured individuals who need to file a claim or report an incident to their insurance company.
03
Employees who want to report a workplace win or loss event to their employer or human resources department.
04
Individuals involved in legal matters, such as court cases or disputes, who require documentation of a win or loss event.
Remember to always follow the specific guidelines provided with the win loss request form and consult any relevant parties or professionals if you have any doubts or questions.
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