| 1 |
Your Personal Contact Information |
| 2 |
A Complete Description of
your Vehicle, including Exterior and Interior Color, Year, Make,
Model, Style and Dealership Where Purchased |
| 3 |
Your Zurich Shield® Warranty
Registration Number and Your
Vehicle Serial Number -
[SHOW ME] |
| 4 |
Date When Damage Was Noticed |
| 5 |
Description of the Cause and
Location of Each Damage
|
| 6 |
Description of Your Attempts
to Remedy the Damage |
