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)
Forms Property & Casualty
Property Arbitration Contentions Sheet
A property subrogation arbitration form.
DOC (28KB)
Forms Property & Casualty
Arbitration Contentions Sheet
The Arbitration Contentions form lists supporting evidence and damage amount in dispute, and is used by both the filing applicant and the respondent.
DOC (28KB)
Forms Property & Casualty
Automobile Accident Report
Report form that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages and witnesses.
PDF (70KB)
Forms Property & Casualty
General Authorization
This form authorizes release of information, and requires a notary signature.
PDF (17KB)
Forms Property & Casualty
Assignment Sheet
Generic form for assigning an automobile claim to an independent adjuster for investigation and handling. The form lists the insurance company, insured, claimant, endorsements, vehicle details, date and description of loss, and contact information for all parties involved.
PDF (47KB)
Forms Property & Casualty
Vehicle Inspection Report
Auto Examiner or Adjuster's vehicle inspection report form.
PDF (22KB)
Forms Property & Casualty
Claim Register Sheet
Basic registry form for logging when claims are received and closed.
PDF (83KB)
Forms Property & Casualty
Notice Under Subrogation Rights
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (13KB)
Forms Property & Casualty
Certificate Of Satisfaction
The insured signs this form which certfies his/her satisfaction with damage repairs performed, directs claim payment to that service provider, and closes the claim.
PDF (25KB)
Forms Property & Casualty
Automobile Proof Of Loss
A policyholder must provide this sworn statement in support of an automobile claim. The notarized form documents the date and cause of loss, vehicle identification, settlement amount, and reserves subrogation and other rights of the insurer.
PDF (46KB)
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)
Forms Property & Casualty
Daily Time Sheet
A daily time sheet to record claims work, hours, mileage and expenses.
PDF (91KB)
Forms Property & Casualty
