Automobile Accident Report (Spanish)
Report form that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages and witnesses.
PDF (97KB)
Auto
Liability
Spanish
Forms Property & Casualty
Notice Under Subrogation Rights
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (13KB)
Auto
Liability
Subrogation
Forms Property & Casualty
Accident Scene Diagram - 3-Lane Highway Intersection
This Microsoft Word template allows users to sketch an accident scene by adding and resizing a variety of objects including roadways, vehicles, traffic signs and other symbols in a 3-lane highway intersection.
DOC (221KB)
Auto
Liability
Diagrams
Model Minimum Uniform Crash Criteria (MMUCC) - 2012
The Model Minimum Uniform Crash Criteria Guideline (MMUCC) is a minimum, standardized data set for describing motor vehicle crashes and the vehicles, persons and environment involved. The Guideline is designed to generate the information necessary to improve highway safety within each state and nationally.
PDF (523KB)
Auto
Liability
Crash Reports
Request For Accident Report
Form letter used by an adjuster requesting an accident report.
DOC (17KB)
Auto
Liability
Letters
Acknowledgement Of Assignment
Generic form used by independent adjusters to acknowledge receipt of a property insurance claim, and provide a preliminary report to the insurance company.
PDF (23KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
New York - Police Accident Report Codes MV-104COV (11/13)
Decipher motor vehicle accident reports in New York with ease using the MV-104COV (11/13) code sheet, a vital resource for claims adjusters and legal professionals. This document lays out crucial codes for assessing accident locations, conditions, vehicle types, damages, and injuries, streamlining the analysis of complex accident reports for efficient claims resolution.
PDF (188KB)
Auto
Liability
Crash Reports
Maine - Crash Report: 13:20 (1/10)
The crash report form used in Maine identifies people and vehicles involved, and contains contributing circumstances, a crash narrative and diagram. Also included is a commercial vehicle supplement and crash report coding guide.
PDF (513KB)
Auto
Liability
Crash Reports
Claimant's Report Of Accident (Spanish)
This report form is given to claimants to record the details of an accident. Includes accident location, property damage, vehicle occupants, witnesses and an accident diagram.
PDF (87KB)
Auto
Liability
Spanish
Forms Property & Casualty
Certificate Of Satisfaction
The insured signs this form which certfies his/her satisfaction with damage repairs performed, directs claim payment to that service provider, and closes the claim.
PDF (25KB)
Auto
Property
Forms Property & Casualty
Automobile Accident/Loss Notice
A loss report form filled out by insureds and/or agents when reporting an automobile accident. Includes information on occupants, injuries, damages, accident description and witnesses.
PDF (65KB)
Auto
Liability
Forms Property & Casualty
Auto Theft Loss Checklist
Similar to form number 9221F, this checklist lists the steps that an adjuster should take when handling an auto theft claim.
PDF (25KB)
Auto
General Reference
Vehicle Bill Of Sale (Spanish)
The vehicle bill of sale is a document that records transaction between buyer and seller, identified by name and address. Bill of sale includes vehicle type, make, model, year, odometer reading, vehicle identification number (VIN) and purchase price.
PDF (26KB)
Auto
Salvage
Forms Property & Casualty
Daily Time Sheet
A daily time sheet to record claims work, hours, mileage and expenses.
PDF (91KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
