Contents Disposal Authorization
Form

4711 Yonge St. FL 10
Toronto, ON M2N 6K8

24/7 EMERGENCY SERVICE:
1.833.378.0701

Contents Disposal Authorization

I, the undersigned, have reviewed the Non-Restorable Contents List (NR List) and hereby authorize the disposal of all contents listed on the NR List, with any and all exceptions listed on the Non-Restorable Items Released to Clients/Insured Form.

Name of Client/Insured

First

Last

Company Name:

Address of Claim:

Address Line 1

City

State / Province / Region

Postal Code

Country

Layout Instructions: Representative:

Complex Claims Representative:

File Number and PM:

Adjuster Authorization ( If available ) :

Additional Comments and Instructions:

Signature

Clear Signature

1-833-378-0701

Contents Disposal Authorization
Form