Letter Of Representation

Letter Of Representation
To whom it may concern,

I am writing to inform you that the insured has retained Telos Adjusting LLC as the representative public adjusting firm in the claim arising from the policy number, peril, and date of loss outlined below:
Name of Insured

First NameLast Name
Customer Email
example@example.com
Insurance Carrier
Policy Number
Cause of Loss
Date of Loss

MonthDayYear
Date
The insured authorizes Telos Adjusting LLC to receive all communications regarding this claim and to make all necessary representations to you, the insurance company, on his/her behalf. The insured authorizes Telos Adjusting LLC to receive and distribute on his/her behalf, as necessary and appropriate, all payments arising out of this claim. The insured further authorizes you, the insurer, to name Telos Adjusting LLC as a co-payee on all payments and benefits resulting from this claim.

The insurer, you, should direct all communications regarding this claim to Telos Adjusting LLC. The insurer should include Telos Adjusting LLC on all claim payment checks and send all checks to Telos Adjusting LLC at the address listed below. The insured explicitly intends to collect all depreciation and all other applicable benefits afforded under the policy. Please advise us as soon as possible of any policy conditions or duties of the insured which may be applicable or necessary to this claim.
Insured Signature*

Clear
Insured Signing Date

MonthDayYear
Date
Telos Adjusting Signature

Clear
Telos Adjusting Signing Date

MonthDayYear
Date
Handling Public Adjusters:

Joseph Kuplack

VA License # 1244337
WV License # 20052645
MD License # 3001628133

Telos Adjusting

VA License # 159320
WV License # 3002993750
MD License # 3003014154
Job Name Unique ID
Account Name
Referral Email
example@example.com
By submitting this form, you acknowledge that your document may be shared with the appropriate parties as needed for your claim processing, including a referring contractor or your insurance carrier.
Should be Empty: