Blank Claim Form definition

Blank Claim Form means a claim form that is not pre-filled with the Settlement Class Member name, date of loss, or Claim ID.
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Blank Claim Form means a paper claim form that is not pre-filled with the Settlement Class Member’s name, address, policy or claim number, claim date of loss, or Claim ID.
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Examples of Blank Claim Form in a sentence

  • If a Claim ID is not available to the Settlement Administrator for the potential Settlement Class Member, the Settlement Administrator shall provide a Blank Claim Form to the requester with instruction that the Blank Claim Form must be mailed to the Settlement Administrator postmarked by the Claims Submission Deadline with the Settlement Class Member name, policy number or claim number, address, and signature.

  • The website shall provide that a Settlement Class Member may submit a Claim Form without a Claimant ID by completing an Electronic Blank Claim Form by entering the Settlement Class Member name and address, and either a policy number or claim number, , and by signing and submitting the Electronic Blank Claim Form electronically.

  • The website shall provide that a Settlement Class Member may submit a Claim Form without a Claimant ID by completing an Electronic Blank Claim Form by entering the Settlement Class Member name and address, and either a policy number or claim number, and by signing and submitting the Electronic Blank Claim Form electronically.

  • The website shall provide that a Settlement Class Member may submit a Claim Form without a Claimant ID by completing an Electronic Blank Claim Form by entering the Settlement Class Member name, policy number or claim number, and address, and by signing and submitting the Electronic Blank Claim Form electronically.