Insurance Notice of Loss
Aatopia Auto Care
96 E. Center St, Logan Utah 84321
Policyholder (Individual Insured on Vehicle):
Policy Holder Address:
City, State, Zip:
Vehicle Information –
How damage occurred:
Date of Loss (date when loss occurred):
*Notice of loss required by Utah State law, section 31A-21-312
I authorize Aatopia Auto Care to act on my behalf in relation to this auto claim. I also authorize all payments, necessary correspondence and policy information to be sent directly or made available to Aatopia Auto Care. I agree to notify my insurance company to inform them of my loss. Pursuant to Utah Admin code R590-190-7 #2, notice of loss given to insurance agent. Pursuant to section 31A-26-303, insured has chosen not to use insurers claim service.
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Your legal name
If you have questions about the contents of this document, you can email the document owner.
Document Name: Insurance Notice of Loss
Agree & Sign