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    Asurion Affidavit Att-Pdffiller PDF

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    Jesse Coffin
    Jesse Coffin is claiming a lost or damaged Samsung Galaxy S20 Ultra 5G. He states that he put an old SIM card into his replacement phone and it would not read the SIM card. He then activated a new SIM card and that also would not read. Mr. Coffin signed an affidavit swearing the information provided is true and acknowledging that insurance fraud is a crime.

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    Asurion Affidavit Att-Pdffiller PDF

    Uploaded by

    Jesse Coffin
    7K views1 page
    Jesse Coffin is claiming a lost or damaged Samsung Galaxy S20 Ultra 5G. He states that he put an old SIM card into his replacement phone and it would not read the SIM card. He then activated a new SIM card and that also would not read. Mr. Coffin signed an affidavit swearing the information provided is true and acknowledging that insurance fraud is a crime.

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    asurion affidavit att-pdffiller.pdf

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    Jesse Coffin is claiming a lost or damaged Samsung Galaxy S20 Ultra 5G. He states that he put an old SIM card into his replacement phone and it would not read the SIM card. He then activated a new SIM card and that also would not read. Mr. Coffin signed an affidavit swearing the information provided is true and acknowledging that insurance fraud is a crime.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7K views1 page

    Asurion Affidavit Att-Pdffiller PDF

    Uploaded by

    Jesse Coffin
    Jesse Coffin is claiming a lost or damaged Samsung Galaxy S20 Ultra 5G. He states that he put an old SIM card into his replacement phone and it would not read the SIM card. He then activated a new SIM card and that also would not read. Mr. Coffin signed an affidavit swearing the information provided is true and acknowledging that insurance fraud is a crime.

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    © All Rights Reserved
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    of 1

    Sworn Affidavit & Proof of Loss Statement

    THE PERSON COMPLETING THIS DOCUMENT MUST BE THE AT&T ACCOUNT HOLDER AND MUST PROVIDE A COPY OF THEIR
    VALID PHOTO ID.

    INSURANCE FRAUD IS A CRIME


    For your protection, a person who knowingly presents a false or fraudulent insurance claim with the intent
    to injure, defraud, or deceive any insurer is guilty of a crime and may be subject to ines and coninement
    in prison. When fraud is discovered, Asurion takes appropriate steps to stop such fraud and explores all
    of its available legal remedies.

    What device are you claiming? ALL FIELDS ARE REQUIRED. PLEASE PRINT USING BLUE OR BLACK INK

    Wireless Number: 9 8 9 6 8 2 0 1 6 9

    Manufacturer: S a m s u n g
    ( Examples: Apple, Samsung, LG, etc. )

    Model: g a l a x y S 2 0 u l t r a 5 G
    ( Examples: iPhone6, GalaxyS5, G3, etc.)

    What happened to the device?

    My Device Is: Lost Stolen Damaged Malfunctioning

    Date of Occurrence: 1/10/2021 Place of Occurrence: home

    Describe What Happened: I put my old sim card in my replacement phone and it wouldn't read the sim card so we activated
    the new sim and it still wouldn't read that sim card either.

    Note: If your device was damaged or malfunctioning, you are required to return it to Asurion upon receipt of your replacement.

    Account Holder information (for veriication purposes only)

    Full Name: Jesse lee Coffin

    Contact Number: 9896820200 Alternate Contact Number: 9896829096

    Email Address: [email protected]

    Billing Address: 217 E Main PO box 293

    City: Maple Rapids State: Mi Zip Code: 48853

    Claim agreement

    I swear/afirm that the device I am claiming is owned by me and that the information provided above is true and accurate. I understand that knowingly presenting false or fraudulent
    information in support of this insurance claim with the intent to injure, defraud, or deceive any insurer is a crime. Asurion may take legal action, including reporting to law enforcement,
    when it suspects fraud in the presentation of insurance claims.
    Verified by PDFFiller
    01/11/2021

    Signature:
    Jesse l. Coffin Date: 1/11/2021
    Web: phoneclaim.com/att-uploader Fax: 1-888-429-7719
    Control # F-017-48-AEN Rev 24 EDT:11/1/07 RDT: 12/4/14
    Asurion Attn: Review Team P.O. Box 413886 Kansas City, MO 64141-3886

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