Power of Attorney for Insurance Claims

Date:
I, the undersigned:
Address:
Contact Number:
hereby appoint:
Address:
Contact Number:
as my true and lawful Attorney-in-Fact to act in my name, place and stead regarding insurance claims with the following insurance company:
Policy Number:
Claim Number (if applicable):
Details/Description of Insurance Claim:
My Attorney-in-Fact shall have full power and authority to:
  • File and pursue insurance claims on my behalf
  • Communicate with the insurance company and its representatives
  • Sign all necessary documents
  • Collect any payments or settlements due
  • Perform all acts necessary to resolve the claim
This Power of Attorney shall remain in effect until revoked in writing by me or upon conclusion of the claim.
Principal's Signature:
Name:
Attorney-in-Fact's Signature:
Name: