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GAP Claim Information Form

You have two (2) options to submit your GAP Claim Information Form. Please use Option 1 to download, fill out form and use the upload form to send it back to us. (or email forms directly to claims@apexprotectionplan.com)

Or use Option 2 below that to fill out the form online, attach required documents and submit.

Option 1

Download, fill out form and use the upload form to send it back to us once complete.

Step 1 – Click button to download form. *Note: you may have to unzip the file once downloaded.

Step 2 – Complete your form. Scan the form and the additionally required forms from the checklist on the document.

Step 3 – Use the form below and “Choose File” and “Submit” your document. Or email it to claims@apexprotectionplan.com

YOU MUST SUBMIT THE COMPLETED CLAIM INFORMATION FORM AND ALL REQUIRED DOCUMENTS WITHIN NINETY (90) DAYS OF THE TOTAL LOSS SETTLEMENT OR WITHIN NINETY (90) DAYS FROM THE DATE OF LOSS IF THE VEHICLE IS NOT INSURED, WHICHEVER IS LATER, OR YOUR CLAIM WILL BE DENIED. FAILURE TO PROVIDE COMPLETE & THOROUGH INFORMATION WILL CAUSE DELAYS IN PROCESSING AND CAN CAUSE YOUR CLAIM TO BE DENIED.

UPLOAD: GAP Claim Information Form and Supporting Documents

Upload your scanned documents in one file below.
Click or drag a file to this area to upload.
Upload a single file .PDF (.PDF files ONLY)

*Additional Documents may be requested during the processing of your claim. Failure to submit the required documents or additional requested documents may cause a delay in the processing of your claim.

Option 2

Fill out the form below to submit your GAP Claim Information Form online.

Send any or all information immediately as there is a time restriction for which to submit your GAP Claim.

YOU MUST SUBMIT THE COMPLETED CLAIM INFORMATION FORM AND ALL REQUIRED DOCUMENTS WITHIN NINETY (90) DAYS OF THE TOTAL LOSS SETTLEMENT OR WITHIN NINETY (90) DAYS FROM THE DATE OF LOSS IF THE VEHICLE IS NOT INSURED, WHICHEVER IS LATER, OR YOUR CLAIM WILL BE DENIED. FAILURE TO PROVIDE COMPLETE & THOROUGH INFORMATION WILL CAUSE DELAYS IN PROCESSING AND CAN CAUSE YOUR CLAIM TO BE DENIED.

Lender/Finance Company

Insurance Information:

Vehicle Usage:

Information Checklist:

Please attach the following items here to process your claim:

Selling Dealership

Click or drag a file to this area to upload.
A copy of the manufacturer’s invoice of the Total Loss vehicle showing MSRP (for new vehicles only). In lieu of the manufacturer’s invoice, you may send a copy of the Monroney Label (.PDF ONLY)
Click or drag a file to this area to upload.
Buyer’s Order or Sales Agreement. (.PDF ONLY)
Click or drag a file to this area to upload.
Proof of any cancellation refunds: Vehicle Service Contract, Credit Life Insurance, etc. (.PDF ONLY)

Lender / Financial Company

Click or drag a file to this area to upload.
A copy of your retail installment sales contract. (.PDF ONLY)
Click or drag a file to this area to upload.
A copy of your COMPLETE payment history from inception of the loan through your Date of Loss. (.PDF ONLY)

Police Department

Click or drag a file to this area to upload.
A copy of the police report - if none was filed, a letter from your insurance company stating the cause of loss and no police report was filed. (.PDF ONLY)

Insurance Adjuster

Click or drag a file to this area to upload.
A copy of the full Vehicle Evaluation Report, showing the method used to calculate the value of your vehicle at Date of Loss. (.PDF ONLY)
Click or drag a file to this area to upload.
A copy of your insurance settlement (showing vehicle value at Date of Loss, applicable taxes and fees and any other adjustments used to arrive at the settlement amount that matches the insurance check amount.) (.PDF ONLY)
Click or drag a file to this area to upload.
A copy of the insurance settlement check or print screen of payment issued. (.PDF ONLY)

*Additional Documents may be requested during the processing of your claim. Failure to submit the required documents or additional requested documents may cause a delay in the processing of your claim.

YOU MUST SUBMIT THE COMPLETED CLAIM INFORMATION FORM AND ALL REQUIRED DOCUMENTS WITHIN NINETY (90) DAYS OF THE TOTAL LOSS SETTLEMENT OR WITHIN NINETY (90) DAYS FROM THE DATE OF LOSS IF THE VEHICLE IS NOT INSURED, WHICHEVER IS LATER, OR YOUR CLAIM WILL BE DENIED. FAILURE TO PROVIDE COMPLETE & THOROUGH INFORMATION WILL CAUSE DELAYS IN PROCESSING AND CAN CAUSE YOUR CLAIM TO BE DENIED.

I understand my signature does not authorize or indicate the Gap Administration Department will obtain these documents on my behalf. You are strongly encouraged to make your scheduled loan payments until your claim is settled. Late fees and interest accrued after the date of loss are not covered and are your responsibility.

Entering my name below serves as my signature and authorizes: (1) my financial institution to release to the GAP Administration Department a detailed payment history, payoff quote, and finance agreement; (2) my insurance company to release to the GAP Administra- tion Department the Insurance Documents referenced above.

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GAP Claim Form

Download and fill out/Submit online.

Get In Touch

(888) 376-8940

Location

5802 N Navarro St Suite 200,
Victoria, TX 77904

Email us 24 hours a day

info@apexprotectionplan.com

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