Customer's Claim & Affidavit (Spanish)
Damage to customer's property is included under a commercial general liability policy; this form describes items lost, seller, purchase date and depreciation. The claim amount is submitted with signature of customer and adjuster.
PDF (61KB)
Liability
Property
Forms Property & Casualty
Attending Physician's Report (Spanish)
A form which is filled out by the attending physician in order to qualify for medical benefits under an automobile insurance policy. (Spanish version of English form 3160F)
PDF (80KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
Alaska - Motor Vehicle Crash Form: 12-209
This form is Alaska driver's self-report form for a motor vehicle crash where the damage is less than $500. It describes the persons, vehicles and circumstances involved, and includes a crash diagram.
PDF (1024KB)
Auto
Liability
Crash Reports
Mississippi - Uniform Crash Report (10/09)
The Mississippi Uniform Crash Report provides driver and vehicle identification, accident circumstances, witness(es), collision diagram and collision narrative.
PDF (96KB)
Auto
Liability
Crash Reports
Texas - Peace Officer's Crash Report: Code Sheet CR-3CS (1/17)
Numbered fields on the CR-3 Texas Peace Officer's crash report refer to the numbered lists on the code sheet.
PDF (181KB)
Auto
Liability
Crash Reports
Missouri - Uniform Accident Report - Pedestrians / Occupants Continuation / Supplement Form: SHP-224
Pedestrians / Occupants Continuation / Supplement (SHP-224) form to the Missouri Uniform Crash Report is completed when more than one pedestrian is involved in a crash or more than six occupants (including the driver) from one vehicle are involved in a crash.
PDF (332KB)
Auto
Liability
Crash Reports
Virgin Islands - Uniform Crash Report: (5/07)
Virgin Islands crash report describes the persons, vehicles and circumstances involved, and includes a collision diagram and narrative.
PDF (106KB)
Auto
Liability
Crash Reports
The Enhanced Fujita Tornado Classification Chart
The Fujita Scale rates the intensity of the tornado (mean wind speed) by the amount of ground damage that is created.
PDF (16KB)
Catastrophe
Property
General Reference
Kentucky Counties Map
This document displays a map of Kentucky with county boundaries and names.
PDF (84KB)
Common
Maps
Release With Medical Agreement (Spanish)
This is a contract that releases an insurer from any legal and financial responsibility for injury and liability claims after a specified time period and medical expense settlement amount is agreed upon.
PDF (75KB)
Liability
Spanish
Forms Property & Casualty
Guarantee Of Title (Spanish)
For a case involving a total loss or theft of a financed motor vehicle or boat, this is an agreement that the lien holder will provide a lien free Certificate of Title to the insurance company upon receipt of a claim payment.
PDF (20KB)
Auto
Liability
Spanish
Forms Property & Casualty
PIP Attending Physician's Report (Spanish)
The attending physician report form is used by an insurer to determine if a person is due benefits under personal injury protection (PIP) law.
PDF (55KB)
Liability
Spanish
Forms Property & Casualty
Employment, Wage & Med. Authorization (Spanish)
An employee authorization form allowing release of employment, wage and medical information to another party.
PDF (85KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
Claim Acknowledgement Letter (Spanish)
A basic MS Word template letter sent as a best practice for the protection of all parties involved. The letter acknowledges receipt of the claim and requests contact with the insured or claimant.
DOC (51KB)
Auto
Liability
Property
Spanish
Workers' Compensation
Letters
