Request for Release of Factual Information

Pursuant to Paragraphs (b) and (i) of the Property Fire Loss Act, Chapter 73, Section 1153 of the Illinois Revised Statutes, (Public Act 80-488 as amended by PA 84-394) a copy of which is attached, request is being made for release of your investigation file, including factual reports, statements of witness, photographs, cause of origin reports, police and fire department reports of the fire described below. The information is being requested as insurer of the interests of the insured in the real and/or personal property involved in the fire loss described below. The requested information will be held in confidence until such time as its release is required, pursuant to the Property Loss Act or criminal or civil proceeding.








Please release information to: