CLAIM SUBMITTAL FORM Instructions  Please fill in the fields below attach necessary documents if available and submit your claim via one of the following contact cha

Document Sample
CLAIM SUBMITTAL FORM Instructions  Please fill in the fields below attach necessary documents if available and submit your claim via one of the following contact cha Powered By Docstoc
					                   CLAIM SUBMITTAL FORM
Instructions:
    Please fill in the fields below, attach necessary documents if available, and submit
      your claim via one of the following contact channels
    Fax: 610-233-4234
    Email: kopclaims@firstam.com
    Mail: First American Title Insurance Company
            Northeast Claims Center:
            620 Freedom Business Center Drive - 4th Floor
            King of Prussia, Pennsylvania 19406

Part 1:Claimant Information
Last Name:                    First Name:                    Date:


Address:                      Email:                         Contact Number/FAX

Part 2: Documents
Please attach the following documents if applicable:                       Enclosed?
Copy of the Title Insurance Policy                                         YES / NO
Copy of HUD-1 Closing Statement                                            YES / NO
Copy of Other Closing Documents                                            YES / NO
Attach all other relevant documents to your claim (please specify):



Part 3: Statement of Claim
Please attach the Statement of Claim and include the following facts
if applicable:
Address of the property (real estate), including state
Title Insurance Policy Number
Explanation for the claim




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