Law Enforcement Financial Institutions
Resume:
%%DPS::SI MPLEX
AUTHORIZATION
Pursuant to this document (or a Photocopy), I hereby authorize: Credit bureaus, consumer reporting agencies, financial institutions, governmental agencies (including law enforcement agencies and the Department of Motor Vehicles), fire department, auto repair/maintenance facilities, auto dealerships, insurance company representatives, utility companies, public and private employers, and employees of any of the above, to furnish to:
Allstate Indemnity Company, its affiliates, and their employees, agents, representatives, or attorneys, all information regarding:
o Credit standing or rating
**Police records mean: traffic, accidental reports, including personal or public records retained by any law enforcement agency relating to criminal arrests or convictions. This Authorization is relative to a loss involving Property which occurred on or about July 03, 2025, and is used exclusively to investigate any and all aspects of this loss or matters pertaining thereto. By signing this authorization, I acknowledge Allstate Indemnity Company does not waive any of the policy terms, conditions, exclusions or limitations by investigating this loss. If the claim involves a property loss, I also give Allstate Indemnity Company, its affiliates, and its employees, agents, representatives and attorneys full permission to enter the premise where the loss occurred for the purpose of conducting any investigation deemed necessary by the Company. This Authorization includes permission to photograph and remove any item or material from the premises for any reason relevant to the investigation of the loss as determined by the Company.
This authorization is valid for the duration of the claim. I understand that I may receive a copy of this authorization upon request.
*Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. SIGNATURE: SOCIAL SEC NO:
PRINT NAME: DATE OF BIRTH:
BY: ADDRESS:
DATE: CITY, STATE, ZIP:
SIUF001
ALLSTATE GROUP-CLAIMS
Allstate Indemnity Company
P.O. BOX 660328
Dallas TX 752660328
UNITED STATES
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Fold here: address must appear in return envelope window ALLSTATE GROUP-CLAIMS
Allstate Indemnity Company
P.O. BOX 660328
Dallas TX 752660328
UNITED STATES
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Fold here: address must appear in return envelope window The office identified above provides claims handling services for the Allstate Group of Insurance Companies, including the underwriting company referenced on the documents accompanying this insert.
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