Insurance Notice of Loss

Aatopia Auto Care 

96 E. Center St, Logan Utah 84321

435-755-6777 service@aatopia.com

Policyholder (Individual Insured on Vehicle):   

Policy Holder Address:   

City, State, Zip:   

Email Address:   

Phone Number:   

Vehicle Information – 




Insurance Company:   





How damage occurred: 


Date of Loss (date when loss occurred): 

*Notice of loss required by Utah State law, section 31A-21-312

I authorize Aatopia Auto Care to act on my behalf in relation to this auto claim. I also authorize all payments, necessary correspondence and policy information to be sent directly or made available to Aatopia Auto Care. I agree to notify my insurance company to inform them of my loss. Pursuant to Utah Admin code R590-190-7 #2, notice of loss given to insurance agent. Pursuant to section 31A-26-303, insured has chosen not to use insurers claim service.


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Signature Certificate
Document name: Insurance Notice of Loss
Unique Document ID: a422176a8d7e4bbef139a80abd6be8e3b0eef9e2
Timestamp Audit
January 4, 2018 4:13 pm MDTInsurance Notice of Loss Uploaded by Shari Hall - shari@aatopia.com IP