Fpl Statement Claimant Form PDF Details

The Florida Power and Light company (FPL) statement claimant form is a document used to notify the company of an incident that has caused damage or loss. The form must be completed within 90 days of the incident, and can be used to request reimbursement for damages or file a claim. In order to complete the form, you will need to provide information about the event, as well as documentation supporting your claim. The FPL statement claimant form is an important resource if you have experienced a problem with your service or account. For more information on how to submit a claim, please visit our website. Thank you for choosing FPL!

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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