Phone 847 583 4600 Fax 847 583 9011 wwwUEG1com Date Claim Number Insured Date of Loss Policy N um ID: 855076
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1 5700 Old Orchard Rd. Skokie, IL 60077
5700 Old Orchard Rd. Skokie, IL 60077 Phone: 847 - 583 - 4600 | Fax: 847 - 583 - 9011 www.UEG1.com Date:______________________ Claim Number: ____________________ Insured: ____________________ Date of Loss: ____________________ Policy N umber: ____________________ V ehicle Involved In Loss: ____________________ Dear Policy Holder: Our investigation of this loss reveals that you or the driver of your vehicle was using the vehicle for business purposes . What kind of business are you in? ______ _________ ___________________________________________________________________ __________________________________________________________________________________ How long have you been using your vehicle in this capacity? ________________________________ __________________________________________________ __________________________________________________________________________________ Does any other driver use your vehicle for work? If so, how often? ____________________________________________________ ______________________________ __________________________________________________________________________________ Please complete and return as soon as possible. | D911Date of Policy Number: Vehicle Involved Policy Holder:of this reveals that you or the driver of your vehicle was using the vehicle for business purposes. What kind your vehicle in this other driver use your work? If Please complete and return as soon as possible.