IMPORTANT NOTICE: The following is a model Notice & Proof of Loss to assist you in drafting your written your

claim for PROPERTY insurance loss. This sample document is intended to give you an idea of a written claim for PROPERTY insurance loss. Insurance claims vary according to circumstance of loss. It is expected that this document will be amended to suit the needs and circumstances arising from your for PROPERTY insurance loss. In most cases, you may need to fill up a particular and claim application form required by your insurance company to process your claim. This model is not a legal advice and is not intended to be a substitute for examining your applicable insurance policy or contract, and the relevant law, legislation, or rules of procedure relating to insurance claims involved which should be examined for specific information. This model is provided for informational and educational purposes only; if you decide to use this model, you may delete this notice and edit the applicable contents of this model (ex., highlighted portion of this model etc) and the author accepts no responsibility for any errors or omissions for such use, and expressly disclaims any such responsibility. ELG www.twitter.com/FilipinoLawyer

Name of Insured stated in the policy Address Email ____ Contact No. ____ Date Sent by personal service Name of Insurance Company Address Fax Attention: Claims Department Dear Sir/Madam, Re: Notice & Proof of Loss for loss incurred on [insert date] Policy No. [stated in the insurance policy] Insured No. [stated in the insurance policy, if any] Insured premises: [stated in the insurance policy]

I write to claim for my/our loss incurred on the above date. I have attached herewith copies of the following documents to support this claim; 1. 2. 3. 4. 5. __________ __________ __________ Itemized list of estimated amount of loss totaling more or less P________ [insert number of photos] Photographs taken for the above loss.

Should you need additional documents or information to support this claim, please inform me in writing exclusively by [choose between Fax / Email / Post Mail] to [Insert fax #, or email address, or address for service] including the name and contact number of your designated claims representative to handle this claim. Prior to such written requisition or after sending thereof, you may reach me at Contact No. ___ to verify the same. I will appreciate your immediate action on this claim so that we can promptly and finally ascertain the loss or damage and your immediate payment of this claim within the mandatory period of thirty (30) days after receipt of this letter and ascertainment of the loss or damage. In all cases, I will expect payment for the loss not later than the mandatory period of ninety (90) days from your receipt of this letter pursuant to Sec. 243 of the Insurance Code of the Philippines. If payment is not made within such 90 day period as per amount of loss stated in this claim or amount of loss agreed with you within the above 30 day period, this letter will not constitute a complete or exhaustive statement of all of my/our rights, claims contentions or legal theories on the above loss or facts underlying them, and all rights or remedies, whether legal or equitable, are hereby expressly reserved. Thank you. Sincerely yours,

Name of Insured

Itemized list of estimated amount of loss totaling more or less P________ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________ ________________ worth _______________