Adjuster's File Invoice
An invoice form used by independent adjusting firms that lists claims investigation expenses billable to the client insurance company.
PDF (48KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
Complete Release Of All Claims (Spanish)
A full release and indemnity agreement which is signed by claimants and releases insurer 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, and against the release.
PDF (95KB)
Liability
Spanish
Forms Property & Casualty
Proof Of Loss (Burglary)
A sworn statement by a policyholder on a theft claim which lists the items stolen and their values. Filled out and notarized, this is a formal request by the insured for payment from the insurance company.
PDF (46KB)
Property
Forms Property & Casualty
PIP Wage & Salary Verification
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.
PDF (33KB)
Liability
Forms Property & Casualty
Adjusters Report/Certification
The Adjusters Report/Certification documents the insured property's location, date and type of loss, and summarizes replacement cost and A.C.V. for buildings, structural, contents and additional living expense, with line item detail.
PDF (47KB)
Property
Forms Property & Casualty
Receipt & Release Medical Payments Coverage
This form is signed by those who qualify as insureds under a policy when collecting medical payments coverage. Used as both a receipt and a release.
PDF (21KB)
Liability
Forms Property & Casualty
Statement As To Replacement Cost Coverage
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (26KB)
Property
Forms Property & Casualty
Release With Medical Agreement
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 (28KB)
Liability
Forms Property & Casualty
Subrogation Receipt
A subrogation receipt is signed by the insured upon payment of a claim, and assigns the insurer to the right to recovery for the loss.
PDF (27KB)
Auto
Liability
Ocean Marine
Property
Forms Property & Casualty
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
