Agreement by which an insurance policyholder assigns the right to receive insurance policy benefits — and the authority to file and negotiate claims — to a third-party service provider (e.g., contractor, restoration company, or healthcare provider) for services rendered after a covered loss.
The Assignment of Benefits (AOB) is a ready-to-use insurance & risk template you can send for signature in minutes. It is written for 2 signers (policyholder and provider) and, by default, expires 30 days after it is sent if left unsigned. It covers assignment of benefits, aob, insurance assignment, contractor, restoration, health insurance. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Assignment of Benefits (AOB) **Agreement Date:** ___________ **Claim Number (if known):** ___________ --- ## 1. Parties **Policyholder / Assignor:** ___________, located at ___________ ("Policyholder" or "Assignor"). **Service Provider / Assignee:** ___________, a ___________ located at ___________ ("Provider" or "Assignee"). **Provider License Number (if applicable):** ___________ --- ## 2. Insurance Policy Information **Insurance Company:** ___________ **Policy Number:** ___________ **Policy Type:** ___________ If Other, specify: ___________ --- ## 3. Covered Loss / Services **Date of Loss / Covered Event:** ___________ **Location of Loss / Property Address:** ___________ **Cause of Loss:** ___________ If Other, describe: ___________