Claim form

HOW TO FILE A CLAIM

If you have a claim under your title insurance policy issued by Title Resources Guaranty Company, you should promptly write to us at:

Title Resources Guaranty Company
8111 LBJ Freeway, Suite 1200
Dallas, Texas 75251

Please state the nature of your claim along with the date and number of your policy and a description of your property. If you are sued, you should immediately send us a copy of the petition served upon you so we may assess the claim. You have a very short time to respond to any lawsuit; therefore, you must send us notice immediately so we can determine if you are covered under the policy. Failure to send us information in writing timely will result in loss of your right to have a defense under the terms of the policy.

For claims on Texas policies, attached is a Texas Department of Insurance promulgated Proof of Loss Form (Form T-40) that you may utilize to give us additional information to begin our assessment of whether your claim is covered by the policy. Despite your having 91 days to fill out this form, if we have no other notice of the claim from you earlier, you could lose your rights of defense under the policy because of shorter times to make defense under Texas laws. DO NOT WAIT TO FILL OUT THE ATTACHED FORM T-40 BEFORE NOTIFYING US IN WRITING THAT A CLAIM EXISTS. In other words, you must give us written notice of the claim as soon as you have reason to believe you have a claim and then fill out and send in the Form T-40 when you have that additional information.

TEXAS TITLE INSURANCE PROOF OF LOSS FORM Please complete all items to the best of your knowledge and return this form to us within 91 days. We will use the form to determine if your loss is covered under the policy.

NOTE: DELAY IN RETURN OF THIS FORM MAY AFFECT OUR ABILITY TO PROMPTLY PROCESS YOUR CLAIM.

FOR INFORMATION OR TO SUBMIT A CLAIM, CALL 1-800-526-8018.

___________________________________________________________________________________________________

Por favor Ilene todos los epigrafes lo mejor que pueda y envienos esta forma dentro de los proximos 91 dias. Nosotros usaremos esta forma al objeto de determinar si su perdida esta cubierta por la poliza.

NOTA: CUALQUIER DEMORA EN ENVIARNOS ESTA FORMA PUEDE AFECTAR NUESTRA CAPACIDAD DE PROCESSAR PRONTAMENTE SU RECLAMACION.

PARA INFORMACION O PARA SOMETER UNA QUEJA, LLAME AL 1-800-526-8018.

Name of Insured(s):
Address of Insured(s):

Telephone Number of Insured(s):
Your interest in the Property:
_______________Owner ______________Mortgagee ______________Other (If other, please explain)
Please complete the following to the best of your knowledge OR attach a copy of your policy:
- a) Date the policy was issued, if known:
  b) Policy number, if known:
  
  c) File or GF number, if known:
  
  d) Name of issuing agent, if known:
  
  e) Legal description of property (see deed or title insurance policy):
  
  f) Street address of property:
Failure to provide enough information for us to identify your policy may result in a delay in processing your claim or denial of your claim.
Please describe the problem you believe affects the title to the property:
Do you have an opinion about the amount of loss or damage caused by the title problems described in Item 4?
______________Yes ______________No
- a) If yes, what is that amount? $_______________. (Please contact us if you need to revise the amount after submitting this form.)
  b) How did you determine this amount? (Please attach any documents you have that show how you determined the amount.)
Have you been sued or threatened with a lawsuit because of the matter described in Item 4?
______________Yes ______________No
- a) If yes, how did you learn of the lawsuit or threatened lawsuit?
  b) Have you been served with a petition or other legal document in a lawsuit?
  ________________Yes ________________No _______________Don't Know
  
  If yes, when and how were you served?

Please attach copies of all documents you have relating to the lawsuit, including letters, the citation, the petition, and the complaint. We may need to ask for additional information about your claim. You are required to provide only the information the policy allows us to ask for.

If two or more persons are named in the policy, both may sign the same form:

_________________________________________
Signature & Date

(Not applicable to the Texas Residential Owner Policy)

STATE OF ________________

COUNTY OF ______________

SWORN AND SUBSCRIBED before me, the undersigned authority, this ____________ day of ________________________, 19_____.

__________________________________________
Notary Public

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Last modified by EF on May 15, 2006