Driver’s Statement

This form provides all the details of an accident per the driver’s written and signed account of the incident.
  PDF (112.742KB) Auto Liability 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

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

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

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

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

Inland Marine Proof Of Loss

Inland Marine Proof of Loss form is a legal document to be completed by an insured in support of a claim.
  PDF (33KB) 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

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

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

Witness Report Of Accident

Witness statement describing an accident in detail.
  PDF (42KB) Auto Liability Forms Property & Casualty

Claim Register Sheet

Basic registry form for logging when claims are received and closed.
  PDF (83KB) Auto Liability Property Workers' Compensation 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

Release Of All Claims

A full release form which is signed by claimants and releases insureds from bodily injury and property damage liability which arose out of an accident, casualty or event. The release form identifies all parties to a claim, states the date and location of the event, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer, or any other parties, for the event.
  PDF (28KB) Liability Forms Property & Casualty

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