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.
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)
Memorandum for Appraisal is used in property damage situations where insured and insurer disagree on actual cash value, and is binding on the parties as to the amount of loss.
This form is used to verify wage and salary information of a person who has applied for personl injury protection (PIP) benefits after an automobile accident.