Free Asurion F-017-08 MEN PDF Form Get Document

Free Asurion F-017-08 MEN PDF Form

The Asurion F-017-08 MEN form is a crucial document designed to streamline the process of filing claims for device protection services. This form allows users to provide essential information needed for processing claims efficiently. To ensure your claim is handled promptly, fill out the form by clicking the button below.

Get Document
Outline

The Asurion F-017-08 MEN form is an essential document used in the claims process for various services and products offered by Asurion. This form plays a crucial role in ensuring that customers receive the support they need when facing issues with their devices or services. It includes sections for personal information, details about the product or service in question, and a description of the issue being reported. Customers must fill out the form accurately to help expedite the claims process. Additionally, it may require specific documentation or proof of purchase to validate the claim. Understanding how to complete this form correctly can significantly impact the speed and efficiency of receiving assistance from Asurion. By providing clear and concise information, customers can facilitate a smoother resolution to their claims, ultimately leading to a better overall experience.

Key takeaways

Here are some key takeaways about filling out and using the Asurion F-017-08 MEN form:

  1. Complete All Sections: Ensure every section of the form is filled out completely. Missing information can delay processing.
  2. Use Clear and Concise Language: Write clearly to avoid confusion. Use simple language to express your points.
  3. Review Before Submission: Double-check all entries for accuracy. A thorough review can prevent errors that may require resubmission.
  4. Keep a Copy: Always retain a copy of the completed form for your records. This can be useful for future reference.
  5. Submit on Time: Be mindful of deadlines. Late submissions may not be accepted.
  6. Follow Up: After submitting, follow up if you do not receive confirmation. Staying proactive can help ensure your request is processed.

Form Preview Example

How to Submit the Required Documentation

&KRRVHDQRSWLRQ2QOLQHRU)D[DQGIROORZWKHVWHSV

DO NOT FAX THIS PAGE

2QOLQH5HFRPPHQGHG

11SJOU mMMPVUBOETJHOUIF4XPSO"GmEBWJU1SPPGPG-PTT4UBUFNFOU

)RXQGRQSDJHRIWKLVGRFXPHQW

4DBOPSUBLFQJDUVSFTPGCPUIUIFDPNQMFUFEBGmEBWJUBOEZPVSWBMJEQIPUP*%

$FFHSWDEOHIRUPVRISKRWR,'YDOLGGULYHU·VOLFHQVHSDVVSRUWIHGHUDOO\LVVXHG,'FDUGRUPDWULFXODFRQVXODU,'

36QMPBECPUIEPDVNFOUTBUQIPOFDMBJNDPNNFUSPVQMPBEFS

)D[

11SJOU mMMPVUBOETJHOUIF4XPSO"GmEBWJU1SPPGPG-PTT4UBUFNFOU

1IPUPDPQZZPVSWBMJEQIPUP*%BOEIBOEXSJUFZPVS$MBJN*%OVNCFSPOUIFQBQFS

3 'BYCPUIEPDVNFOUTUP

+RZWRSUHYHQWGHOD\VLQSURFHVVLQJ\RXUFODLP

7KHGRFXPHQWLVPDUNHGZLWKDEDUFRGHWKDWLVVSHFLÀFWR\RXUFODLP8VLQJDSKRWRFRS\ZLWKDQLQFRUUHFWEDUFRGHZLOOGHOD\\RXUFODLP 0DNHVXUH\RXKDYHDYDOLGSKRWR,'

$FFHSWDEOHIRUPVRISKRWR,'YDOLGGULYHU·VOLFHQVHSDVVSRUWIHGHUDOO\LVVXHG,'FDUGRUPDWULFXODFRQVXODU,'

8QDFFHSWDEOHIRUPVRI,'VWXGHQW,'ZRUN,'ELUWKFHUWLILFDWH, military ID, common access card,DQG6RFLDO6HFXULW\FDUG

1DPHRQWKH,'PXVWPDWFKQDPHRIWKH0HWUR$FFRXQW2ZQHUZKRFRPSOHWHVWKH6ZRUQ$IÀGDYLW 3URRIRI/RVV6WDWHPHQW

,IQDPHGRHVQRWPDWFKWKHQ\RXPD\QHHGWRSURYLGHDGGLWLRQDOGRFXPHQWDWLRQ

7KH,'FDQQRWEHH[SLUHG,IWKH,'DSSHDUVDOWHUHGIRUJHGLOOHJLWLPDWHRUXQUHDGDEOHZHZLOOQRWEHDEOHWRSURFHHGZLWK\RXUFODLP

0DNHVXUHDOOGRFXPHQWVFDQVRUID[HVDUHFOHDUDQGHDV\WRUHDG

:KHQPDNLQJWKHSKRWRFRS\RI\RXUSKRWR,'FRQVLGHUXVLQJWKHHQODUJHDQGFRQWUDVWVHWWLQJVWRPDNHWKH,'HDVLHUWRUHDG

%ODFNDQGZKLWHFRSLHVDUHSUHIHUUHG

+RZWRÀQG\RXUGHYLFHPDQXIDFWXUHUPRGHODQG(610(,',0(,

)RUPRVWGHYLFHV

For Android products:

)RU$SSOHSURGXFWV

)LQGWKLVLQIRUPDWLRQRQ

/RJLQWRJRRJOHFRPGDVKERDUG

2SHQL7XQHV

%DFNRIWKHSKRQHGHYLFHRUXQGHUWKHEDWWHU\

&OLFNWKH$QGURLGVHFWLRQWRGLVSOD\

&KRRVHL7XQHV!3UHIHUHQFHVLQ0DF26;

QRWDOOEDWWHULHVDUHDFFHVVLEOH

(610(,',0(,

&KRRVH(GLW!3UHIHUHQFHVLQ:LQGRZV

<RXU&XVWRPHU$JUHHPHQW

 

&OLFNWKH'HYLFHVWDE

DYDLODEOHDWSKRQHFODLPFRPPHWUR

 

3RVLWLRQWKHPRXVHRYHU´%DFNXS'HYLFHµ

7KHER[WKHSKRQHGHYLFHFDPHLQWRGLVSOD\(610(,',0(,

,IQRQHRIWKHVHLWHPVDUHDYDLODEOHSOHDVHFRQWDFW 0HWUR

9LVLWXVRQOLQHDWSKRQHFODLPFRPPHWURRUFDOO$VXULRQDWIRUTXHVWLRQVUHJDUGLQJWKHFODLPVSURFHVV

Sworn Affdavit & Proof of Loss Statement

5)*4%0$6.&/5.645#&$0.1-&5&%#:"/"$$06/508/&30/:063.&5308*3&-&44"$$06/5

5)&1&340/$0.1-&5*/(5)&%0$6.&/5.645"-401307*%&"1)050$01:0'5)&*37"-*%1)050*%

,1685$1&()5$8',6$&5,0(

)RU\RXUSURWHFWLRQDSHUVRQZKRNQRZLQJO\SUHVHQWVDIDOVHRUIUDXGXOHQWLQVXUDQFHFODLPZLWK WKHLQWHQWWRLQMXUHGHIUDXGRUGHFHLYHDQ\LQVXUHULVJXLOW\RIDFULPHDQGPD\EHVXEMHFWWR ÀQHVDQGFRQÀQHPHQWLQSULVRQ:KHQIUDXGLVGLVFRYHUHG$VXULRQWDNHVDSSURSULDWHVWHSVWR

VWRSVXFKIUDXGDQGH[SORUHVDOORILWVDYDLODEOHOHJDOUHPHGLHV

:KDWGHYLFHDUH\RXFODLPLQJ"$//),(/'6$5(5(48,5('3/($6(35,1786,1*%/8(25%/$&.,1.

Claim ID:

0DQXIDFWXUHU

&YBNQMFT4BNTVOH -( ;5& FUD

:LUHOHVV1XPEHU

0RGHO

&YBNQMFT(BMBYZ4 ' ;."9 FUD

(610(,',0(,

3FGFSUPUIFJOTUSVDUJPOTPOUIFQSFWJPVTQBHF

:KDWKDSSHQHGWRWKHGHYLFH"

0\'HYLFH,V /RVW 6WROHQ 'DPDJHG 0DOIXQFWLRQLQJ

'DWHRI2FFXUUHQFH

 

 

3ODFHRI2FFXUUHQFH

 

'HVFULEH:KDW+DSSHQHG

 

 

 

$FFRXQW2ZQHULQIRUPDWLRQ

)XOO1DPH

 

 

 

 

 

 

 

3ULPDU\3KRQH

 

$OWHUQDWH3KRQH

 

 

 

Email Address:

 

 

 

 

 

 

 

 

 

%LOOLQJ$GGUHVV

 

 

 

 

 

 

 

 

&LW\

 

 

 

 

 

 

6WDWH

 

 

Zip Code:

 

&ODLPDJUHHPHQW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,KHUHE\PDNHDQLQVXUDQFHFODLPDJDLQVWWKHLQVXUDQFHFRPSDQ\DVVKRZQRQWKLVLQVXUDQFHFODLPDIÀGDYLW,DFNQRZOHGJHWKDWLIDQ\SURSHUW\ZKLFKLVWKHVXEMHFWRI WKLVFODLPDQGZKLFKLVUHSODFHGRUSDLGIRUE\WKHLQVXUHULVUHFRYHUHGDWDQ\WLPHLWLVWKHSURSHUW\RIWKHLQVXUDQFHFRPSDQ\DQGPXVWEHUHWXUQHGWRWKHLQVXUDQFH FRPSDQ\,XQGHUVWDQGWKDWLI,IDLOWRUHWXUQVXFKSURSHUW\,DPVXEMHFWWRDQGDXWKRUL]HDQRQUHWXUQIHHRIXSWRWREHFKDUJHGXQGHUWKHLQVXUDQFHSROLF\XVLQJ WKHPHWKRGRISD\PHQWXVHGWRRULJLQDOO\ÀOHWKLVFODLP

,VZHDUDIÀUPWKDWWKHGHYLFH,DPFODLPLQJLVRZQHGE\PHDQGWKDWWKHLQIRUPDWLRQSURYLGHGDERYHLVWUXHDQGDFFXUDWH,XQGHUVWDQGWKDWNQRZLQJO\SUHVHQWLQJ IDOVHRUIUDXGXOHQWLQIRUPDWLRQLQVXSSRUWRIWKLVLQVXUDQFHFODLPZLWKWKHLQWHQWWRLQMXUHGHIUDXGRUGHFHLYHDQ\LQVXUHULVDFULPH$VXULRQPD\WDNHOHJDO

DFWLRQLQFOXGLQJUHSRUWLQJWRODZHQIRUFHPHQWZKHQLWVXVSHFWVIUDXGLQWKHSUHVHQWDWLRQRILQVXUDQFHFODLPV

6LJQDWXUH

 

 

Date:

 

 

&RQWURO)0(15HYEDT5'7

Web: pKRQHFODLPFRPPHWURXSORDGHU )D[

$VXULRQ$WWQ5HYLHZ7HDP32%R[.DQVDV&LW\02