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BOTH SIDES OF CLAIM FORM MUST BE COMPLETED AND RETURNED WITH ITEMIZED BILLS WITHIN 30 DAYS.MAIL TO: Administrative Concepts, Inc. P.O. Box 4000 Collierville, PA 194269000 www.acitpa.comEDI MAYOR ID#

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How to fill out both sides of claim

01

Start by obtaining a claim form from your insurance provider.

02

Fill out the basic information such as your name, policy number, and contact information on the front side of the claim form.

03

Provide a detailed description of the incident that led to the claim on the front side of the form.

04

Attach any relevant supporting documents such as receipts, photos, or police reports to the front side of the claim form.

05

Once the front side is completed, flip the form over to the back side.

06

Fill out any additional information requested on the back side of the claim form.

07

Review the entire form to ensure all information is accurate and complete before submitting it to your insurance provider.

Who needs both sides of claim?

01

Anyone who has experienced an incident that may be covered by their insurance policy needs to fill out both sides of a claim form.

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What is both sides of claim?

Both sides of claim refers to the documentation submitted by both the insured party and the insurance company detailing their account of an insurance claim.

Who is required to file both sides of claim?

Both the insured party and the insurance company are required to file both sides of claim.

How to fill out both sides of claim?

Both sides of the claim should be filled out accurately and completely, providing all relevant information and documentation.

What is the purpose of both sides of claim?

The purpose of both sides of claim is to present the respective accounts of the insured party and the insurance company regarding an insurance claim.

What information must be reported on both sides of claim?

Both sides of claim must include details such as the date of the incident, the nature of the claim, any relevant documentation or evidence, and contact information for both parties.

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