Sworn Affidavit & Proof of Loss Statement "r48 0OSUVENT Mus Be COWELETED BY AN ACCOUNT OWNERIACOOUNT MANAGER ON YOUR VERON WIRELESS ACCOUNT ‘THE PERSON COMPLETING THE DOCUMENT MUST ALSO PROVIDE A PHOTO COPY OF THEIR VALID PHOTO I eMart Cea D ‘What device are you claiming? ALL FIELDS ARE REQUIRED. PLEASE PRINT USING BLUE OF BLACK INK como HL PLB LOO weeenmon 2OB-b Ht 4-477 tanacen: PRUPIPILIE TL wot LIPIHONE 2S comaonet 3514 68 OS3E5S LEOL What happened to the device? Wyoeerm: Clon NUienen Cloeaged Cintra ode ot Ooarone 2‘ 1G: 1E> rece tOoxrenee: TEIN IT Deserte wnat Happenec: PHONE. WWE eat ca ATA A Wity ADLEN Account Owneriaceount Manager ntrmation vatnore ee rmary Prone: AYA) earners Saree ® Salo. COV). ae owe OL mek R26 yooh unread tht knowingly * ae AAO Signature: asurion j=Cama Yinr2sien IN SESH 3652 20. (Phony Se 78 2806DONOT FAX THIS PAGE How to Submit the Required Documentation Choose an option (Online or Fax) and follow the steps | Online (Recommended) | 1 Print, fill out and sign the Sworn Affidavit & Proof of Loss Statement. | Acoeptati ams of hot ID: ald crver’loense, passport, fedealy issued D card or matioua consular. 2 Scan or take pictures of both the completed affidavit and your valid photo * 3 Upload both documents at phoneclsim.comiverizon-uploader rm | + Print, fill out and sign the Sworn A\fidavit & Proof of Loss Statement. | _7?. Photo copy, 1Adrite your Claim ID number on the paper. Row 3 Fax both | | fays in processing your claim marked with a barcode that is specific to your clam. Using a photocopy with an Incorect barcode wl delay your calm eve vale photo 1D feforms.f photo 1D val vrs ionse passport feral sued ID cae or mae consur 1D ‘Unacceptable rms of: student D, werk I, ith eta and Soil Sacuny cars Namen the 1D must match name the Verizon Acccurt Oans/Acsount Manager whe complaae te Som Ata & Prono Les Staemnt {fname dos not match, then you nay need o provide acksional documentaten| “The ID cannot be expred. te 1D aopeers eed rye, gitar unreadable, we wi robe ae oFrocen wt ou mn Mako eure al document scans or fx re clear and eng to 280 \wnen making th pote copy your hot 1D, consider Us the erage and contrast stings o make the D easier o ead ‘lack and whe copies are protec How to find your device manufacturer, model and ESN/MEIDAME! For Apple precuts: For Android product: Formost devices: een Tunes Log ino google. comtashboars Fr hie inernation on ‘Choose Tunes > Petererces in Mee OS x (ack tne Andro secton to slay Back ofthe phoneldevie or unre batry Choose Elt>Prterncesin windows ESNIEIDAME! (rotal bates are acsossble) (xine Daves 20 Your Custer Agroament Poston the mouseover "sackup Dov” (avaible at verzenirless com) ‘ogpay ESNWEIDIME! ‘The box the phonalvice cama in rane of hae ims ate aval lease contact verzon Wels Vist us ontin at phancinim.comierizce/ag Of ell ASUion at 1-888-681-2622 for questions regarding the claims process. asurion >