Fpl Statement Claimant Form PDF Details

In the intricate matrix of consumer rights and utility responsibilities, the Statement of Claimant form, particularly designed for food loss claims, emerges as a crucial document for individuals facing the distressing experience of food spoilage due to electricity outages or similar incidents. This form stands as the first step towards seeking restitution, mandating claimants to furnish comprehensive details including their personal information, specifics of the incident such as date, time, and location, alongside an itemized list of lost food with its respective cost. The process underscores the importance of attaching supporting documentation like original purchase receipts and photographs to corroborate the claim. Submission avenues are varied, offering the claimants the flexibility to forward their completed forms and attached evidence through email, fax, or traditional mail, directly to the designated address. It's pertinent to note the form also serves as a legal document where claimants authorize the Florida Power & Light Company (FPL) to initiate an investigation into their claim. The investigation's commencement hinges on the claimant's compliance with providing all requisite information and documentation. Moreover, the statement at the document's closure serves as a stern reminder about the legal ramifications of submitting false information, aligning with Florida's stringent laws against insurance fraud. This initiation process, while detailed, encapsulates a path for individuals to seek compensation for their losses, tethered closely to principles of accountability and justice within the sphere of utility services.

QuestionAnswer
Form NameFpl Statement Claimant Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfpl claim statement, claimant food loss, fpl claims statement, statement food loss

Form Preview Example

STATEMENT OF CLAIMANT

(FOOD LOSS)

Complete the information below in its entirety, attach documentation to support your claim (e.g. Original purchase receipts, photos), and send in via Email to Public-Claims@fpl.com or alternatively via Fax at (305) 626-7694, or US mail at FPL-Public Claims LAW/SCS, P.O. BOX 25209, Miami, Florida 33102-9862. Failure to comply will postpone indefinitely the investigation of the claim until such time as these requirements have been fulfilled.

NAME ________________________________________ DATE OF INCIDENT ________________________

ADDRESS______________________________________CITY___________________________ZIP_________

PREFERRED#____________________________________ALT#_____________________________________

PLACE OF INCIDENT_______________________________________________________________________

DATE AND TIME OF OCCURRENCE ___________________________________________________________

ITEMQUANTITYCOST

________________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

TOTAL AMOUNT OF LOSS __________________________________________________________________

ATTACH ALL PROOF OF LOSS FOR ABOVE ITEMS.

I AUTHORIZE FPL TO INVESTIGATE MY CLAIM. FPL WILL NOT DETERMINE LIABILITY UNTIL ALL OF THE FACTS OF THIS MATTER, ALONG WITH THE REQUESTED DOCUMENTATION, HAVE BEEN REVIEWED.

SIGNATURE_______________________________________________ DATE______________________

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD OR DECEIVE ANY INSURANCE COMPANY FILES A STATEMENT OF CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE. FLORIDA STATUTE 817.234

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