DEBT CANCELLATION CONTRACT
CLAIM WORKSHEET
DATE: 12/11/2018 5:01:40 PM
IMPORTANT NOTE: Total loss incident must be reported to Program Administrator within the time indicated in the contract purchased.

ATTACH/FAX COMPLETE AND LEGIBLE COPIES OF THE FOLLOWING ITEMS:

GAP CONTRACT
  • A copy of the GAP Contract.
PRIMARY INSURANCE ITEMS
  • Settlement Valuation - A copy of the primary insurance itemized settlement valuation worksheet which must include the odometer reading as of the date of loss (e.g. CCC or ADP Valuation Report).
  • Settlement Check - A copy of the primary insurance settlement check is required.
POLICE REPORT
  • A clear and legible copy of the police report made for the incident.
DEALER/LENDER ITEMS
  • Finance Agreement - A copy of the Lender (finance company, credit union, bank etc.) Finance Agreement completed when the vehicle was originally purchased.
  • Loan Payment History - A copy of the loan payment history which clearly itemizes the account activity.
CANCELABLE INSURANCE(S) OR AGREEMENT(S)

Note: Only the consumer can cancel these outstanding policies/contracts.
  • If a service contract, mechanical breakdown insurance, Credit Life and/or Credit Disability Insurance or any other such CANCELABLE items were sold along with the vehicle, then these must be cancelled as of the date of loss and a copy of the refund calculation and/or refund check must be provided.
GAP PLUS BENEFIT
  • A consumer who purchases the GAP Plus Benefit from the Lender who financed the vehicle must return to that same Lender to finance a replacement vehicle and submit a copy of the Lender finance agreement for the replacement vehicle. If the GAP Plus Benefit was purchased through the Dealer, you must submit the Dealer's bill of sale or retail installment agreement for the replacement vehicle.
Please feel free to contact us if we may be of further assistance at 619-228-0100 - Option 1 (GAP Claims Department) or send items via fax to 619-228-0129.



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