Professional Documents
Culture Documents
11/15/2017
Please read these instructions prior to completing the paperwork. Failure to follow
instructions may result in a delay in processing your claim.
1. All parties listed on the original title must sign their name (exactly how it appears on
the title first, middle, and last name format.
2. Please be advised that this form is required to be notarized.
3. Any strikeouts, erasures, or use of “white out” will void documents and/or title.
4. Please return the completed original documents along with all keys/remotes that are
still in your possession to one of the addresses below.
If you have any questions, please feel free to contact us at 1-800-691-4312, Monday
through Friday 8am to 9pm EST.
Sincerely,
Elizabeth Powell
EC0242 (02/2015)
1-800-691-4312
Claims Department
KNOW ALL MEN BY THESE PRESENTS, that the undersigned for valuable consideration paid or to be paid does hereby grant,
sell, transfer and deliver unto (grantee) the motor vehicle described below:
Odometer Reading:
To have and to hold all and singular the said goods and chattels to said grantee, its successors and assigns. The undersigned
covenants with said grantee that the undersigned is the lawful owner of said goods and chattels, that they are free from all
encumbrances, that the undersigned has a good right to sell the same; that the undersigned will warrant and defend same against
the lawful claims and demands of all persons.
________________________________
_
Seller (sign as your name appears on
title)
________________________________________________________________________________________________________
_
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS that the undersigned owner(s) ___________________________________________
of the following described motor vehicle, 2002, FORD EXPLOR LTD Serial No. 1FMZU75EX2ZA27001 hereby constitute and
appoint ___________________________of GEICO INSURANCE my (or our) true and lawful Attorney to sign in the name,
place, and stead of, the undersigned any Certificates of Ownership issued by the Division of Motor Vehicles of the State covering
the vehicle described above in whatever manner necessary to transfer any registration of said vehicle as they deem fit and proper.
IN WITNESS WHEREOF, the undersigned does hereby set his hand and seal this ____________day of ___________,
________.
________________________________
___
Seller (Sign as name appears on title
SUBSCRIBED AND AFFIRMED, BEFORE ME THIS _________ day of _________________, ________, in the County of
___________________________ _____________________
NOTARY PUBLIC SIGNATURE COMMISSION EXPIRES