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PJ Disclosure and Contract 3.doc

PJ Disclosure and Contract 3.doc 2025

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The document is a contract between the Insured and Paul Dix, a licensed Public Insurance Adjuster, outlining the terms of representation for filing an insurance claim. It specifies the adjuster's responsibilities, payment structure based on a percentage of the settlement, and the Insured's rights to cancel the contract within three business days without penalty. Additionally, it provides information about different types of insurance adjusters and emphasizes that public adjusters work solely for the Insured.

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Click ‘Get Form’ to open the PJ Disclosure and Contract 3.doc in the editor.
Begin by entering the Public Insurance Adjuster’s name, Paul Dix, along with his address, license number, telephone, and email in the designated fields.
In the section labeled 'Insured', fill in your name and details regarding the loss you are claiming. Specify the date of occurrence and provide a description of the peril.
Complete the insurer's information including their name, policy number, and claim number as required.
Indicate your agreement on payment terms by filling in the percentage fee for services rendered after signing this contract. Don’t forget to initial where indicated.
Sign and date the contract at the bottom to finalize your agreement with Paul Dix Adjusters.
Review the Notice of Cancellation section carefully. If you wish to cancel within three business days, ensure you follow the outlined procedure for cancellation.

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