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
Schedule Of Contents (Spanish)
A contents inventory form, with columns to itemize place and date of purchase, cost, condition, actual value and amount claimed.
PDF (40KB)
Property
Spanish
Forms Property & Casualty
Release And Trust Agreement (UM/UIM PD) (Spanish)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim involving property damage.
PDF (75KB)
Liability
Property
Spanish
Subrogation
Forms Property & Casualty
Automobile Proof Of Loss (Spanish)
A policyholder must provide this sworn statement in support of an automobile claim. The notarized form documents the date and cause of loss, vehicle identification, settlement amount, and reserves subrogation and other rights of the insurer.
PDF (86KB)
Auto
Liability
Spanish
Forms Property & Casualty
Non-Auto Liability Accident Notice (Spanish)
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (88KB)
Liability
Spanish
Forms Property & Casualty
Employment-Wage Authorization (Spanish)
A person uses this form to authorize an employer to release his or her employment and wage records to a third party.
PDF (86KB)
Liability
Spanish
Workers' Compensation
Forms Property & Casualty
General Authorization (Spanish)
This form authorizes release of information, and requires a notary signature.
PDF (85KB)
Liability
Spanish
Special Investigations
Workers' Compensation
Forms Property & Casualty
General Release (Husband & Wife) (Spanish)
A legal form that absolves an insurer from any further liability for a claim upon acceptance of a settlement amount by a married couple.
PDF (105KB)
Liability
Spanish
Forms Property & Casualty
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
