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AHIS Our goal is to process your claim

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The AHIS Our goal is to process your claim form is 5 pages long and contains:

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  • 18 check-boxes
  • 54 other fields

Country of origin: OTHERS
File type: PDF

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AHIS
Our goal is to process your claim as quickly as possible. Listed below are the required documents needed in
order for us to review your claim request. Copies of documents must be obtained by you and submitted
to us. If you do not have the required documentation it can be obtained from:
Your Lender
Financing Contract (Loan/Lease Agreement)
Payoff amount as of date of loss and full loan history
Your Insurance Company Information (*)
Vehicle Valuation Statement
Estimate of damage
Insurance Settlement Check
Police Report for Accident or Theft. (If collision and no police report filed, written statement of loss)
Theft Recovery Report (If vehicle is recovered only)
Insurance Policy (declaration page only)
(*) If you do not have primary coverage please contact our claims office immediately.
Your Dealership
Financing Contract (Loan/Lease Agreement)
Factory Invoice (Only if the vehicle was new at time of purchase)
Buyers Order (Motorcycles only) (California: Bill of sale or accessory list)
Also, please provide a statement of loss.
The GAP administrator will not obtain any of the above information for you. The GAP
Administrator must receive this documentation within 90 days of settlement by your primary
insurance carrier. Benefit may be denied if this documentation is not provided to the GAP
Administrator within the stated time period. Documents can be mailed to P.O. BOX 260098,
Miami, Fl, 33126-0098 or they can be faxed to 866-378-6409
To obtain refunds on cancelable products you will need to contact your selling
dealership and request cancellation. Cancelable products you may have purchased
include: Extended Warranty/Service Agreement, Maintenance Agreement, Credit
life and Disability, Etch (Cancelable in the state of Florida only) or any other
cancelable or refundable products not mentioned above.
If we are not provided with the refund amounts prior to the processing of your
GAP claim, these refund amounts will be pro-rated.
If the refund amounts are pro-rated please have your lender or dealership provide
copies of actual refund amount. If the pro-rated refund amount is higher then the
actual refund your claim will be recalculated and additional benefit will be
extended.
To help assist you in obtaining the necessary documents we have included form letters which can
be
forwarded to the issuing Lender/Credit Union, Primary Insurance Company and Dealer.
If you have any questions regarding your claim or this process please contact our office. Our office hours
are Monday through Friday 8:30 AM to 7:00 PM Eastern Standard Time.
GAP Administrator
AHIS P.O BOX 260098
Miami, Fl, 33126-0098
FAX: 866-378-6409
GAP CLAIM LETTER TO LENDER
GAP Claim Number:
__________________________________
Today’s Date
_______________________
Your Name
__________________________________
Street Address
__________________________________
City, State Zip
_______________________ _______________________
Lender Name Loan Number
__________________________________
Street Address
__________________________________
City, State Zip
Dear Loan Department Representative:
I financed my ________ ____________ ____________ through you on ___________.
Year Make Model Loan date
This vehicle was totaled on ______________________. I must submit the
documentation listed below to my GAP administrator immediately in order to complete
the GAP claim process. Please send copies of the following documentation to me at the
address listed above as well as a copy to my GAP administrator at:
These documents can either be mailed to: P.O. Box 260098
Miami, Fl, 33126-0098
Or they can be faxed to: 866-378-6409
Documents requested:
Loan agreement
Payoff amount of loan as of loss date and full loan history
Notice of fund amounts for refundable products
Check only those documents you do not currently have possession of.
Sincerely,
______________________________
Signature
_____________________________________________
Print Name
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signature
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GAP CLAIM LETTER TO DEALER
GAP Claim Number:
Complete the appropriate fields below and mail to your dealer.
ANCELLABLE PRODUCTS
__________________________________
Today’s Date
______________________
Your Name
__________________________________
Street Address
__________________________________
City, State Zip
_______________________
Dealership Name
__________________________________
Street Address
__________________________________
City, State Zip
Dear Dealership Finance Representative:
I purchased my ________ ____________ ____________ at your dealership on ______.
Year Make Model
This vehicle was totaled on ______________________. I must submit the
documentation listed below to my GAP administrator immediately in order to complete
the GAP claim process. Please send copies of the following documentation to me at the
address listed above as well as a copy to my GAP administrator at:
These documents can either be mailed to: P.O. Box 260098
Miami, Fl, 33126-0098
Or they can be faxed to: 866-378-6409
Documents requested:
Loan agreement
Factory Invoice (New Vehicles Only)
Buyers order (Motorcycles Only) accessory list for California
Notice of fund amounts for refundable products
Check only those documents you do not currently have possession of.
Sincerely,
______________________________
Signature
_____________________________________________
Print Name
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signature
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GAP CLAIM LETTER TO PRIMARY INSURANCE CARRIER
GAP Claim Number:
Complete the appropriate fields below and mail to your primary insurance carrier.
ANCELLABLE PRODUCTS
__________________________________
Today’s Date
__________________________________
Your Name
__________________________________
Street Address
__________________________________
City, State Zip
__________________________________ __________________________________
Primary Insurance Carrier Name Your claim number
__________________________________
Street Address
__________________________________
City, State Zip
Dear Claims Representative:
My ________ ____________ ____________ was totaled on ____________________.
Year Make Model Accident date
I must submit the documentation listed below to my GAP administrator immediately in
order to complete the GAP claim process. Please send copies of the following
documentation to me at the address listed above as well as a copy to my GAP
administrator at:
These documents can either be mailed to: P.O. Box 260098
Miami, Fl, 33126-0098
Or they can be faxed to: 866-378-6409
o Insurance company vehicle valuation statement
o Estimate of damage and photos if available
o Insurance company check and/or settlement statement
o Theft recovery report (if vehicle is recovered only)
o Declaration page of primary vehicle insurance policy
Check only those documents you do not currently have possession of.
Sincerely,
______________________________
Signature
_____________________________________________
Print Name
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signature
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AHIS Our goal is to process your claim

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Completed 2 February 2021

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