Release & Trust Agreement (UM/UIM BI)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim. Requires the insured to cooperate in the recovery of funds from the responsible party.
PDF (24KB)
Auto
Liability
Subrogation
Forms Property & Casualty
Building Repair Estimate
Form used to calculate building repair costs, which includes replacement and actual cash value appraisal of the damaged property, and an itemized list of building materials, quantities, and labor.
PDF (83KB)
Catastrophe
Property
Forms Property & Casualty
Recorded Statement Analysis
A written observation describing behavior of a person making a recorded statement.
PDF (54KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
Parent/Guardian Release
This legal form for Parent/Guardian releases an insurer from any liability or indemnity claim for damages or injuries resulting from an accident involving a minor in exchange for a monetary settlement.
PDF (25KB)
Liability
Forms Property & Casualty
Release & Subrogation Receipt
A legal form signed by an insured acknowledging receipt of settlement and release of all subrogation rights to the insurer.
PDF (29KB)
Auto
Property
Subrogation
Forms Property & Casualty
4 Column Adjuster Worksheet
Financial worksheet for calculating a repair estimate, with one column to itemize losses, and 4 columns for replacement cost, quantity or age, depreciation, and actual cash value.
PDF (79KB)
Auto
Management & Underwriting
Property
Forms Property & Casualty
Release & Authorization Of Payment
Used as a general release form which is signed by insureds and specifies payment to settle a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer for the loss event.
PDF (26KB)
Auto
Liability
Property
Forms Property & Casualty
Property Loss Worksheet (Spanish)
Use this worksheet to inventory property and content losses, and obtain an estimate of replacement costs. It contains columns to factor in age, original cost, replacement cost and depreciation to calculate ACV (actual cash value).
PDF (91KB)
Property
Forms Property & Casualty
PIP Application For Benefits
This application form to obtain personal injury protection benefits requests information regarding claimant's employment, income, injury, treatment dates and medical bills received, plus any loss of wages due to the accident.
PDF (33KB)
Liability
Forms Property & Casualty
Witness Report Of Accident
Witness statement describing an accident in detail.
PDF (42KB)
Auto
Liability
Forms Property & Casualty
Claimant's Report Of Accident
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 (76KB)
Auto
Liability
Forms Property & Casualty
Customer's Claim & Affidavit
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 (59KB)
Liability
Property
Forms Property & Casualty
Employment, Wage & Med. Authorization
An employee authorization form allowing release of employment, wage and medical information to another party.
PDF (17KB)
Liability
Workers' Compensation
Forms Property & Casualty
Non-Waiver Agreement / Reservation Of Rights
The non-waiver agreement is signed by the policyholder; its purpose is to protect the insurer. Insurer reserves all of its rights under the policy to investigate and defend a claim without admission of any liability for loss.
PDF (36KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
