Insurance Claim Process Your guide to accessing funds to repair your home.
Table of Contents Type 1: Claims Under $10,000 1 Type 2: Claims Exceeding $10,000 2 Forms: Loss Draft Claim Form 3 Taxpayer Information 4 Mortgagor s Affidavit of Repair Certification 5 Waiver of Lien (sample) 6 Waiver of Lien 7 Letter of Satisfaction 8 Contact Information: Mail Address: Phone: Email: Flagstar Bank c/o PFIC (866) 734-8160 FSBlossdraft@pfic.com 5225 Crooks Road Troy, MI, 48098-2823
» TYPE 1 CLAIMS Like you, we want your home to be restored as quickly as possible. We ve created this guide to help you understand the insurance claim process and submit the forms required to report your claim. If your claim is $10,000 or less Documents You Will Need: q Adjustor s report q Claim check from insurance company What You Need to Do: 1. Report your claim to us. Once you ve filed a claim and your homeowner s insurance company has determined a settlement amount, report your claim to us by calling (866) 734-8160. 2. Deliver your claim check to us. Once you receive your claim check from your insurance company, mail it with the adjustor s report to us using the contact information on the inside cover. We ll endorse it and return it to you so you can use the money to pay for repairs. Note: Have all parties sign your claim check before mailing it to us. This includes your second mortgage, if any. (Be sure to use the process above ONLY if $10,000 or LESS is your total claim from the adjustor s report and not the amount of the check. ) 1
» TYPE 2 CLAIMS If your claim exceeds $10,000 Documents You Will Need: q Adjustor s report q Signed and accepted contractor s proposal q Copy of contractor s liability insurance q IRS W-9 Form or the Request for Taxpayer Identification Number and Certification completed and signed by the contractor q Contractor s lien waiver* q Signed and notarized Mortgagor s Affidavit of Repair Certification q Authorization to mail funds to alternate temporary address q Claim check from insurance company q Letter of Satisfaction * Not required until work is complete. What You Need to Do: 1. Once you ve filed a claim and your homeowner s insurance company has determined a settlement amount, report your claim to us by calling (866) 734-8160. 2. After you receive your claim check from your insurance company, make sure all parties listed on the check, except Flagstar, endorse the check. 3. Provide the check, along with copies of the documents required above, to us by mailing them using the contact information provided on the inside cover. Once the documents and check are received and logged in, we will send you a letter outlining the next steps. (Be sure to use the process above ONLY if the total claim from the adjustor s report and not the amount of the check exceeds $10,000.) 2
» LOSS DRAFT CLAIM FORM Name: Name: Loan Number: # Property Address: Mailing Address: Phone Number: Email: Preferred method of contact: q Phone q Mail q Email Preferred contact time: morning afternoon evening Insurance adjustor s name: Phone Number: Please list all persons authorized to speak on claim, not previously listed: If you have any questions, please call us at (866) 734-8160, Monday-Friday 8:30 a.m. -5 p.m. ET. We also can be reached by email at FSBlossdraft@pfic.com Please complete and return to: Flagstar Bank c/o PFIC Attention: Loss Draft Department 5225 Crooks Road Troy, MI 48098-2833 3
» TAXPAYER INFORMATION Request for Taxpayer Identification Number and Certification (Substitute Form W-9) All sections of this form must be completed. Borrower: Loan Number: # Property Address: Contractor: Name (as shown on your income tax return) Business name/disregarded entity name, if different Check appropriate box for federal tax classification; check only one of the following seven boxes: q Individual/sole proprietor or q C Corporation q S Corporation q Partnership q Trust/estate single-member LLC q Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note: For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner. q Other (see instructions at: http://www.irs.gov/pub/irs-pdf/fw9.pdf ) 1. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3). Exempt payee code (if any): Exemption from FATCA reporting code (if any): 2. Street Address (and apt. or suite no.): City, State, and ZIP Code: Part I - Taxpayer Identification Number (TIN) Social Security Number or Employer Identification Number Part II - Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions at http://www.irs.gov/pub/irs-pdf/fw9.pdf. Contractor Signature 4 Date
» MORTGAGOR S AFFIDAVIT OF REPAIR CERTIFICATION All sections of this form must be completed. Loan Number: Property Address: County, Parish: I/we, the undersigned mortgagor(s) here by state that the damages sustained at our property, will be/ have been completed per the insurance adjustor s scope and will/does comply with all the applicable state and local codes and regulations governing residential repair or reconstruction, including, but not limited to building codes, zoning codes, work permits and inspections. I/we the undersigned mortgagor(s) also hereby state that all bills for materials and labor will be/have been paid from the insurance loss proceeds. There will be no Mechanics Liens or Material providers liens filed as a result of lack of payment for the repair/ reconstruction work. I/we the undersigned mortgagor(s) acknowledge that upon execution of this Affidavit, insurance loss proceeds will be released per Flagstar Bank guidelines. Funds are released in incremental disbursements. Upon completion of work and at each draw request, an insurance loss inspection will be scheduled to confirm percentage of completion. With satisfactory results, Waiver of liens from contractors, and letter of satisfaction of repairs from the borrower, the final payment will be disbursed. Borrower s Name (please print) Borrower s Signature Date Co-Borrower s Name (please print) Co-Borrower s Signature Date Sworn to before me and subscribed in my presence on this day: State of: County/Parish of: Notary signature: My commission expires: 5
» WAIVER OF LIEN WAIVER OF LIEN My/our contact with To provide For the improvement to Check One (If work is complete, please select Full Conditional or Full Unconditional) q Partial Conditional Total amount paid to date including expected. Hereby waive my/our construction lien to the amount of $, for the labor/materials provided through (date). This waiver, together with all previous waivers, if any, (circle one) does/does not cover all the amounts due to me/us for the contract improvement provided through the date shown above. This waiver is conditioned on actual payment of $. Amount expected. q Partial Unconditional Amount paid to date. Having been fully paid and satisfied, hereby waive my/our construction lien to the amount of $ for labor/ materials provided through (dates). This waiver, together with all previous waivers, if any, (circle one) does/ does not cover all amounts due to me/us for contract improvement provided through the date shown above. Circle does not if owed funds. q Full Conditional Having been fully paid and satisfied, all my/our construction lien rights against such property are hereby waived and released. This waiver is conditional on actual payment of $. The amount owed. q Full Unconditional SAMPLE Having been fully paid and satisfied, all my/our construction lien rights against such property are hereby waived and released. Contractor has been paid in full. Company: Address: Phone: Sworn Statement All workers and all merchandise obtained by us/me will be the responsibility of the undersigned: 6
» WAIVER OF LIEN WAIVER OF LIEN My/our contact with To provide For the improvement to Check One (If work is complete, please select Full Conditional or Full Unconditional) q Partial Conditional Hereby waive my/our construction lien to the amount of $, for the labor/materials provided through (date). This waiver, together with all previous waivers, if any, (circle one) does/does not cover all the amounts due to me/us for the contract improvement provided through the date shown above. This waiver is conditioned on actual payment of $. q Partial Unconditional Having been fully paid and satisfied, hereby waive my/our construction lien to the amount of $ for labor/ materials provided through (dates). This waiver, together with all previous waivers, if any, (circle one) does/ does not cover all amounts due to me/us for contract improvement provided through the date shown above. q Full Conditional Having been fully paid and satisfied, all my/our construction lien rights against such property are hereby waived and released. This waiver is conditional on actual payment of $. q Full Unconditional Having been fully paid and satisfied, all my/our construction lien rights against such property are hereby waived and released. Company: Address: Sworn Statement Phone: All workers and all merchandise obtained by us/me will be the responsibility of the undersigned: 7
» LETTER OF SATISFACTION To: Flagstar Bank 5151 Corporate Drive Troy, MI 48098-2639 Re: Property Loss Claim Loan #: Sworn Statement I/We hereby certify that the restoration, repairs or improvements have been partially/completed and the property is in as good or better condition than existed prior to the loss, and that I/We are fully satisfied with the repairs. Owner Owner 8