Claims Pages
claimspages

Vehicle Bill Of Sale

The vehicle bill of sale is a document that records transaction between buyer and seller. Bill of sale includes vehicle type, make, year, vehicle identification number (VIN) and purchase price.
  PDF (20 KB) Forms Property & Casualty

Vehicle Inspection Report

Auto Examiner or Adjuster's vehicle inspection report form.
  PDF (22 KB) 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 (47 KB) Forms Property & Casualty

Claim Register Sheet

Basic registry form for logging when claims are received and closed.
  PDF (83 KB) Forms Property & Casualty

Property Arbitration Contentions Sheet

A property subrogation arbitration form.
  DOC (28 KB) Forms Property & Casualty

General Authorization

This form authorizes release of information, and requires a notary signature.
  PDF (17 KB) 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 (28 KB) 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 (13 KB) 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 (79 KB) 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 (25 KB) 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 (46 KB) Forms Property & Casualty

Special Arbitration Filing Form

The special arbitration form identifies the parties and allegations involved in a dispute, and lists supporting evidence.
  DOC (52 KB) 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 (47 KB) Forms Property & Casualty