ANPAC - SCA Appraisal
Please check the box
indicating the areas of damage. F
APPRAISAL REPORT
|Claim # |VIN # |Mileage |License Plate: |Production Date: |
|Owners Name |Year |Make |Model |Packages |
| 2 Door 4 Door Truck: Long bed Short | Straight Side Flare Side 2WD 4WD Diesel Convertible |
|Color: |Engine Size: Ltr: |Trans: OD |Turbo? YES NO | Drivable Towable |
|Power Options |Seating |Roof | Aftermarket Film Tint |
|Power Steering |Cloth Seats |Electric Glass Roof |Privacy Glass |
|Power Brakes |Bucket Seats |Electric Steel Roof |Fog Lamps |
|Power Windows |Reclining/Lounge Seats |Flip Roof |Luggage/Roof Rack |
|Power Locks |Leather Seats |Skyview Roof |Rear Spoiler |
|Power Mirrors |Heated Seats |Manual Steel Roof |Rear Window Wiper |
|Power Driver Seat |3rd Row Seat |Hard Top |Headlamp Washers |
|Power Passenger Seat |Captain Chairs (2),(4),(6), |Dual Power Sunroof |Signal Integrated Mirrors |
|Power Trunk/Gate Release |Rear Heated Seats |Manual Glass Roof |Woodgrain |
|Power Adjustable Pedals |12 Passenger Seating |Safety/Brakes |Clearcoat Paint |
|Power Sliding Door |Retractable Seats |Drivers Side Air Bag |Metallic Paint |
|Dual Power Sliding Doors |Power Third Seat |Passenger Air Bag |Two Tone Paint |
|Décor/Convenience |15 Passenger Seating |Anti-Lock Brakes (4) |Three Stage Paint |
|Air Conditioning |Ventilated Seats |4-Wheel Disc Brakes |Other-Trucks |
|Climate Control |Radio |Front Side Impact Air Bags |Rear Step Bumper |
|Dual Air Conditioning |AM Radio |Head/Curtain Air Bags |Trailer Hitch |
|Tilt Wheel |FM Radio |Positraction |Trailer Package |
|Cruise Control |Stereo |Backup Camera |Rear Sliding Window |
|Rear Defogger |Search/Seek |Parking Sensors |Running Boar/Side Steps |
|Intermittent Wipers |CD Player |Rear Side Impact Air Bags |Power Rear Window |
|Console/Storage |Cassette |Communications System |Bedliner |
|Overhead Console |Steering Wheel Touch Controls |Hands Free |Soft Tonneau Cover |
|Memory Package |Auxiliary Audio Connection |Heads Up Display |Dual Rear Wheels |
|Navigation System |Premium Radio |Anti-Lock Brakes (2) |Auxiliary Fuel Tank |
|Entertainment Center |Satellite Radio |Xenon Headlamps |Bedliner (Spray On) |
|Dual Screen Entertainment |CD Changer/Stacker |Alarm |Grill Guard |
|Keyless Entry |Equalizer |Traction Control |Hard Tonneau Cover |
|Telescopic Wheel |Wheels |Stability Control |Power Retractable Running Boards |
|Message Center |Styled Steel Wheels |Intelligent Cruise |Bed Rails |
|Home Link |Full Wheel covers |Night Vision |Deluxe Truck Cap |
|Remote Starter |Clad Wheels |Roll Bar |Winch |
|Wood Interior Trim |Aluminum/Alloy Wheels |Lane Departure Warning |Snow Package |
| |Chrome Wheels |Blind Sport Detection |Tool Box(Permanent) |
| |20” or Larger Wheels |Exterior/Paint/Glass |Stone Guard |
| |Wire Wheels |Dual Mirrors |California Emissions |
| |Wire Wheel Covers |Heated Mirrors |Other: |
| |Locking Wheels |Body Side Moldings |Other: |
| | |Tinted Glass | |
|Unrelated/Prior Damage: |
|ECA Ratings |Comments: |Shop Name: |
|Seats: F G VG EX Tires | |Address: |
|Carpet: F G VG EX | |Name of Contact Person: |
|Dashboard: F G VG EX /32 Front | |Federal Tax Id: |
|Headliner: F G VG EX /32 Rear | |Shop of owners Choice: YES NO |
|Body: F G VG EX | |Copy Left with Owner: YES NO |
|Glass: F G VG EX | |Copy Left with Shop: YES NO |
|Paint: F G VG EX | |Location of Inspection: |
|Engine: F G VG EX | |Date Inspected: |
|Transmission: F G VG EX | | |
|*Any rating other than GOOD will require comments and/or | | |
|photos* | | |
| |TOW: |Labor/Teardown |Storage per day | |
| |$ |$ |$ | |
For your protection, state laws require the following to appear on this form:
Applicable in Arizona
For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.
(Applicable in Kentucky, Minnesota, New Hampshire, New Jersey, New York)
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime (the following is applicable in New York) and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each violation.
Applicable in California and Arkansas
Any person who knowingly presents a false or fraudulent claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
Applicable in Colorado
It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.
Applicable in Florida
Any person who knowingly and with intent to injure, defraud, or deceive any insurance company files a statement of claim containing any false, incomplete or misleading information is guilty of a felony of a third degree.
Applicable in Idaho
Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement containing any false, incomplete or misleading information is guilty of a felony.
Applicable in Indiana
A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete or misleading information commits a felony.
Applicable in Nevada
Pursuant to NRS 686A.291, any person who knowingly and willfully files a claim that contains any false, incomplete or misleading information concerning a material fact is guilty of a felony.
Applicable in New Mexico
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties.
Applicable in Ohio
Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
Applicable in Oklahoma
WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
Applicable in Pennsylvania
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
Applicable in Tennessee, Texas, Virginia
It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
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American National Corporate Centre
1949 East Sunshine
Springfield, MO • 65899-0001
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