0. NM OSI FORM

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Policyholder Agreement
Todays Date*

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Date
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1st Named Insured*

First NameLast Name
Insured Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insured Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Policy Number*
Claim Number*
Insurance Company*
Insurance Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Assumed Date of Loss*

MonthDayYear
Date
Possible Cause of Loss?*
Insured Phone Number*
Format: (000) 000-0000.
Insured Email Address*
example@example.com

This Policyholder Statement Agreement is made between you and HELPWITHMYPOLICY DOT COM LLC and It's Operation's Manager, Public Adjuster, Joseph Xavier Valverde (19552406 NM Residency) for the purpose of facilitating the claims process and ensuring that you receive the maximum benefits from your insurance policy. By signing this Agreement, you allow HELPWITHMYPOLICY DOT COM to act on your behalf, ensuring professional representation throughout the claims process.*

I am entering in to an agreement with HELPWITHMYPOLICY DOT COM LLC, (helpwithmypolicy.com).

Definitions
Definitions HELPWITHMYPOLICY DOT COM: The licensed entity represented by its Public Adjuster. A Public Adjuster in the State of New Mexico, dedicated to advocating for your rights and maximizing your claim benefits.You and Related Terms: Refers to the individual or entity holding the insurance policy issued by the Insurer. As the claimant, we retain ultimate control over the claim while you benefit from our professional assistance.Insurer: the company providing the insurance coverage. Understanding your relationship with the Insurer is crucial as it influences how your claims are processed.Public Adjuster: A licensed professional who specializes in managing insurance claims on behalf of policyholders. You are engaging HELPWITHMYPOLICY DOT COM to significantly enhance your chances of a favorable outcome, as they possess the expertise to navigate complex insurance processes.Insured: You as the insured party under the Policy, entitled to claim benefits for covered losses.Claim: The formal request for payment or benefits under the insurance policy as a result of the damages incurred.Benefits: Any and all insurance proceeds, payouts, or claim settlements arising from the insurance policy related to the Property.Property: The real property located at the insured address which is the subject of the Claim.*

Yes, as the Policyholder, I agree with the definitions above!

Agreement

Reassignment
1. Assignment of BenefitsYou irrevocably assign and transfer to HELPWITHMYPOLICY DOT COM all rights and interestsin any Benefits arising from the insurance policy.Benefit: This empowers HELPWITHMYPOLICY DOT COM to negotiate directly with the Insureron your behalf, streamlining the process and increasing the chances of a successful claim.*
2. Scope of AssignmentThis includes the authority to collect insurance proceeds, negotiate settlements, and makedecisions regarding repairs or other actions related to the Claim.Benefit: By allowing HELPWITHMYPOLICY DOT COM to manage these aspects, you alleviatethe stress and complexity associated with claims management.*
3. Limitations on Assignment HELPWITHMYPOLICY DOT COM shall not be liable for any obligations you may have arising from the insurance policy. Benefit: This protects you from any potential liabilities associated with the Claim, ensuring that your interests are safeguarded.*
4. Authority to Act You grant HELPWITHMYPOLICY DOT COM authority to act on your behalf regarding the Claim. Benefit: This delegation of authority allows for swift action and decision-making, which is critical in the claims process.*
5. Acknowledgment of Authority You acknowledge HELPWITHMYPOLICY DOT COM's comprehensive authority to negotiate and settle claims as needed. Benefit: Understanding the extent of this authority ensures that you remain informed and engaged in the process.*
6. Notification Requirement You agree to notify the Insurer of this assignment and provide any necessary documentation to facilitate this process. Benefit: Prompt notification helps in expediting the claims process, ensuring that your claim is addressed without unnecessary delays.*
7. Exclusive Negotiation Rights HELPWITHMYPOLICY DOT COM shall be the sole representative for negotiating with the Insurer (insurance company) regarding the Claim. Benefit: This exclusivity ensures that your claim is handled with the utmost professionalism and expertise.*
8. Negotiation Procedures HELPWITHMYPOLICY DOT COM will keep you informed of developments and obtain your approval for any settlements before finalizing. Benefit: This keeps you in the loop and ensures that you have a say in the final outcome of the negotiations.*
9. Handling Legal Proceedings HELPWITHMYPOLICY DOT COM will handle all legal proceedings related to the Claim, if necessary. Benefit: If disputes arise, having a professional manage legal challenges significantly reduces stress and increases your chances of a favorable resolution.*
10. Engagement of Legal Counsel HELPWITHMYPOLICY DOT COM may engage legal counsel on your behalf for any legal matters arising from the Claim. Benefit: Access to legal expertise can be invaluable in complex situations, ensuring that your rights are fully protected.*
11. No Separate Counsel You will not engage a separate attorney without HELPWITHMYPOLICY DOT COM's consent. Benefit: This provision helps maintain a unified strategy in handling the Claim, maximizing the potential for success.*
12. Fees for HELPWITHMYPOLICY DOT COM. You agree to pay HELPWITHMYPOLICY DOT COM a fee of 10% for the services rendered. Benefit: Understanding the costs upfront allows for better financial planning and ensures that you receive quality services and transparency.*
13. Future Legal ExpensesYou shall be responsible for any future legal expenses agreed upon with HELPWITHMYPOLICY, only if necessary.Benefit: This clarity prevents unexpected financial burdens later in the process.*
14. Percentage of HELPWITHMYPOLICY DOT COM's Fees HELPWITHMYPOLICY DOT COM shall receive a fee equal to 10% of the total recovery amount. A cap of 10%. Benefit: This performance-based fee structure aligns HELPWITHMYPOLICY DOT COM's interests with yours, motivating them to secure the best possible outcome for you.*
15. Payment Terms You agree to the payment terms outlined by HELPWITHMYPOLICY DOT COM and understand that these will be detailed in an invoice. Benefit: Clear payment terms help you manage your finances and ensure transparency in the transaction.*
16. No Guarantee of OutcomeHELPWITHMYPOLICY DOT COM makes no guarantees regarding the outcome of legal proceedings or negotiations with the Insurer.Benefit: While outcomes cannot be guaranteed, having a professional advocate increases the likelihood of a favorable resolution.*
17. Binding Nature You acknowledge the binding nature of this Agreement and its implications. Benefit: Understanding the legal significance of this Agreement ensures you are fully aware of your rights and obligations.*
18. Right to Dissolve You retain the right to dissolve this Agreement within three days of execution by providing written notice to HELPWITHMYPOLICY DOT COM. Benefit: This flexibility allows you to reconsider your options should circumstances change.*
19. Cooperation with HELPWITHMYPOLICY DOT COM You agree to cooperate fully with HELPWITHMYPOLICY DOT COM, providing necessary information and access to the Property. Benefit: Your active participation enhances HELPWITHMYPOLICY DOT COM's ability to advocate effectively on your behalf.*
20. Access to Property You will provide access to the Property for inspections and assessments as needed. Benefit: Facilitating access helps ensure that your claim is thoroughly evaluated and processed efficiently.*

A. Confidentiality Obligations: Both parties agree to maintain confidentiality regarding this Agreement and any related information. Benefit: This ensures that sensitive information is protected throughout the claims process.*
B. Indemnification by You: You agree to indemnify HELPWITHMYPOLICY DOT COM from any claims arising from any misrepresentation or omission of information you provide. Benefit: This protects HELPWITHMYPOLICY DOT COM from liability, allowing them to focus on securing your benefits.*
C. Limitation of Liability: HELPWITHMYPOLICY DOT COM will not be liable for any losses incurred by you as a result of decisions made in good faith based on the information you provide. Benefit: This provision ensures that HELPWITHMYPOLICY DOT COM can operate without fear of litigation for honest mistakes, allowing for a more effective claims process.*
D. Governing Law: This Agreement shall be governed by the laws of the State of New Mexico. Benefit: Familiarity with local laws ensures that you understand your rights and obligations under this Agreement.*
E. Entire Agreement: This document represents the entire agreement between the parties regarding the Claim and supersedes all prior agreements or understandings. Benefit: Clarity and comprehensiveness reduce the likelihood of disputes arising from misunderstandings.*
The parties hereto have executed this Policyholder Statement Agreement as of the date first above written, with HELPWITHMYPOLICY DOT COM as the sole signatory.
HELPWITHMYPOLICY DOT COM*
Fee to Public Adjuster*
Policyholder Signiture*

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Policyholder Agreement

Definitions

Agreement