Summary
Overview
Work History
Education
Skills
Paymentoptions
Claimsubmissioninstructions
Requireddocuments
Processingtime
Primarymembersignature
Underwriter
Mailingaddress
Insuredprimaryaddress
Memberemail
Memberalternatephone
Memberprimaryphone
Homeclaimdeductibleamount
Autoclaimdeductibleamount
Vehicleinformation
Lossinformation
Achauthorizationform
Locations
Timeline
Hi, I’m

Phillip Brooks

Frankfort,KY
Phillip Brooks

Summary

I am a felon ( child support)

Overview

3
years of professional experience

Work History

Shaw Secure Solutions

Security Officer
06.2021 - Current

Job overview

Check visitors in and out of truck lot .

Education

Franklin County High School
Frankfort, KY

High School

University Overview

Skills

  • Report Writing
  • Incident Reporting
  • Security Guard License
  • General security
  • Surveillance
  • Patrol operations
  • Visitor tracking
  • Threat Assessment
  • Electronic surveillance
  • Document Management
  • Crime Prevention
  • Patrolling
  • Security camera monitoring

Paymentoptions

Paymentoptions
QUICK PAY OPTION- For approved claims, receive payment within 48 business hours of claim approval. Complete page 2 of this claim form to enable ACH payment direct to your account; OR, STANDARD PAYMENT OPTION - For approved claims, a check will be sent within 7 business days of claim approval. NOTE: If you do not complete page 2 of this claim form to enable ACH Payment, claim payment will be sent in the form of a check via US mail.

Claimsubmissioninstructions

Claimsubmissioninstructions
Please complete this form, sign it electronically, and complete the on-line claim submission instructions below. 1) Create and save a digital copy of the completed and signed claim form (scan, pdf, jpeg, etc.) to your electronic device. 2) Go to the online process: https://claims.cynosurefinancial.com/FIMC 3) Enter your Member Number (ex.1234567AB) and your last name to log in. 4) Select the appropriate claim # from the open claims list. 5) Click "Browse..." Navigate to the digital copy of the signed claim form and any other requested supporting documents you wish to upload and select them. 6) Click "Upload Claim Documents" to complete the upload process.

Requireddocuments

Requireddocuments
  • This completed and signed Claim Form. This form must be signed by the Member, or the Primary Member's spouse, if family coverage applies.
  • Your Insurance Policy "Declarations Page(s)" which shows your policy was in effect on the Date of Loss. (This is part of your Insurance Policy that was provided to you from your Primary Home or Auto Insurance Company).
  • Proof of Payment from your Insurance Company showing items such as the date of loss, date paid, to whom paid, the amount they paid on your claim, and the deductible amount that was removed from the loss settlement payment.
  • Final Estimate of Repairs or Valuation Report (total loss claims only) for the loss being claimed.
  • Your vehicle registration, or proof of vehicle ownership, in force on the Date of Loss (Auto Deductible Claims Only).
  • Any other information that may be reasonably requested by the Claims Administrator to process your claim.

Processingtime

Processingtime
Please allow up to 21 business days for processing your claim. Your claim will be delayed if all items are not received. (Please review your benefits as not all benefits are available in all states.)

Primarymembersignature

Primarymembersignature
Primary Member (or Spouse's) Signature:____________________________________________________Date:___________________ I hereby acknowledge that I am signing this claim form electronically and this electronic signature is valid.

Underwriter

Underwriter
American Bankers Insurance Company of Florida

Mailingaddress

Mailingaddress
Same Same Same Same, Same, Same, Same

Insuredprimaryaddress

Insuredprimaryaddress
Same Same Same Same, Same, Same, Same

Memberemail

Memberemail
plb91191@gmail.com

Memberalternatephone

Memberalternatephone
5023197038

Memberprimaryphone

Memberprimaryphone
5023197038

Homeclaimdeductibleamount

Homeclaimdeductibleamount
______________

Autoclaimdeductibleamount

Autoclaimdeductibleamount
______________

Vehicleinformation

Vehicleinformation
3kPF24AD7ME364426, 2021, KIA, Forte

Lossinformation

Lossinformation
12/21/2023, Frankfort, KY 40601-1492, ____________________MEMBER _________________________OTHER, Was sitting in turning lane to turn left. Light was red. A pickup truck was turning right, pulling a gooseneck flat bed trailer. He swung wide, I tried backing up, but my car was struck by the trailer. Damage to the front and right front side of my car.

Achauthorizationform

Achauthorizationform
  • ACH AUTHORIZATION FORM: If your claim is approved for payment, you have the option to request an ACH payment, instead of a mailed check payment. If you wish to have your approved reimbursement sent to you (the Member) via ACH payment please fill out the form below. Authorization Agreement for Auto-Credit (ACH Credit) I (we) hereby authorize cynoSure Financial, Inc. (Company) hereinafter called Company, to initiate automatic credit entries to my (our) account indicated below at the financial institution named below, hereinafter called Depository, and to debit the same to such account. Bank Details Checking Savings Accountholder(s) Name _________________________________________________ (The Accountholder must include the name of the Member.) Bank Name ___________________________ Account Number _________________________ Routing Number _________________________ (If applicable, include leading zeros and dashes in the Account Number and Routing Number.) This authorization is to remain in full force and effect until Company has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it. Written notification may be provided to cynoSure Financial, Inc., PO Box 7690, St. Clair Shores, MI 48080 or via email at homeandautoclaims@cynosurefinancial.com. Accountholder Signature
  • Date ______________________________________________ Printed Name I hereby acknowledge that I am signing this claim form electronically and this electronic signature is valid. Accountholder Signature
  • Date ______________________________________________ Printed Name I hereby acknowledge that I am signing this claim form electronically and this electronic signature is valid. Note: ALL WRITTEN CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR (COMPANY) IN THE MANNER SPECIFIED IN THE AUTHORIZATION.
  • Typed or printed signatures are not acceptable unless the electronic signature box above is checked. If the box is not checked, the signature may be an actual signature or an electronic signature.

Locations

Locations
  • Same Same Same Same, Same, Same, Same

Timeline

Security Officer
Shaw Secure Solutions
06.2021 - Current
Franklin County High School
High School
Phillip Brooks