Headstart Warranty Group
Gap Claim Form

Gap Claim Form


ATTACH COMPLETE & LEGIBLE COPIES OF THE FOLLOWING ITEMS—ANY ITEMS THAT ARE MISSING WILL DELAY PROCESSING OF YOUR CLAIM

FROM YOU:

  • COPY OF POLICE OR FIRE REPORT—if there is no police or fire report, please include a statement of what happened. 
  • COPY OF THE ACTUAL CASH VALUE WORKSHEET FROM YOUR PRIMARY INSURANCE COMPANY SHOWING HOW THEY ARRIVED AT THEIR PAYMENT
  • MILEAGE AS OF THE DATE OF PURCHASE and THE DATE OF LOSS

FROM YOU OR YOUR LENDER OR YOUR DEALER WHERE THE VEHICLE WAS PURCHASED:

  • COPY OF THE LOAN AGREEMENT
  • COPY OF THE BUYERS ORDER
  • COPY OF THE GAP INSURANCE POLICY

FROM YOUR LENDER:

  • A COMPLETE PAYMENT HISTORY
  • THE PAYOFF AS OF THE DATE OF LOSS
  • NAME AND ADDRESS WHERE PAYMENT SHOULD BE SENT

FROM YOUR DEALER:

  • THE AMOUNTS OF THE REFUNDS ON ANY EXTENDED SERVICE CONTRACTS, CREDIT INSURANCE OR OTHER PRODUCTS WHICH WERE FINANCED—you must contact your dealer to get these refunded to your lender.  They must be applied to your loan before we can make our payment.  Check your loan agreement to see if you financed any of these products.