Automobile Accident Promissory Note
Customized automobile subrogation promissory note which allows the insurance company to notify DMV/BMV in case of default by the tortfeasor.
PDF (17KB)
Auto
Liability
Subrogation
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
Statement Of Loss With Enclosures
An adjuster's statement of a loss using Schedules A, B & C, that includes enclosures.
PDF (61KB)
Property
Forms Property & Casualty
Sworn Statement In Proof Of Loss (w/Subrogation)
A notarized statement of the money claimed for a loss under a property coverage policy, which includes giving insurer the right to recovery.
PDF (94KB)
Ocean Marine
Property
Subrogation
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
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
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
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
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
