To help ensure the security of your handset insurance claim and identification, on occasion, we will need additional information.

If you have been asked to provide us with some additional information, we need you to complete the form and fax it to us along with the requested identification. Please click on the link below and print the form.

Questions about the affidavit? Click here for help

PDF format requires Adobe Acrobat Reader which is available for free

How to Return the Form?
Quick Option : Fax the form to Asurion at 1-888-832-0511

Slow Option : Mail the form and copy of your valid ID to the following address:
Asurion Attn: Claims Documentation Processing
PO Box 413886
Kansas City, MO 64141-3886

After your Claim Affidavit form has been received and processed, a Customer Service Representative will contact to complete your claim. You simply come back here – type in your claim number and you are on the fast track to completion!

Total Equipment Protection combines the coverage of the Equipment Replacement Program and the Equipment Service & Repair Program in one complete package. Each program available separately.

Equipment Replacement Program
* Insurance coverage for loss, stolen or physically damaged devices
* $50 or $100 non-refundable deductible applies per approved insurance replacement (depending upon your device). Please refer to the deductible schedule for a list of phones and associated deductibles
* For terms and conditions, see the coverage certificate

Equipment Service & Repair Program
* Provides coverage for mechanical or electrical failure, routine maintenance or failure
from normal wear and tear
* No additional out of pocket expenses to repair or replace your malfunctioning device
* For terms and conditions, see the service contract

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The Equipment Replacement Program is underwritten by Continental Casualty Company, a CNA company, and administered by Asurion Protection Services, LLC, a licensed agent of CNA.