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 (70 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
Property Arbitration Filing Form
A property subrogation arbitration form.
DOC (55 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
Adjuster's Loss Certification and Apportionment of Claim
This form is used to recommend to the insurer the amount of payment for a loss, and apportionment when a property is covered by two or more insurance companies.
PDF (21 KB)
Forms Property & Casualty
General Release (Husband & Wife)
A legal form that absolves an insurer from any further liability for a claim upon acceptance of a settlement amount by a married couple.
PDF (26 KB)
Forms Property & Casualty
Medical Authorization (HIPAA Compliant) (Spanish)
Authorization form for disclosure of medical records, in compliance with HIPAA requirements.
PDF (76 KB)
Forms Property & Casualty
Statement Of Loss With Enclosures
An adjuster's statement of a loss using Schedules A, B & C, that includes enclosures.
PDF (61 KB)
Forms Property & Casualty
Automobile Accident Report (Spanish)
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 (97 KB)
Forms Property & Casualty
Corporation Release
A release and indemnity agreement for a corporation, which releases insurer from 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.
PDF (26 KB)
Forms Property & Casualty
Affidavit Of Salvage Retention (Spanish)
Acknowledgment by the current owner that his vehicle has been declared a total loss, and that he/she has elected to retain the salvage for a specific sum of monies. Towing and storage charges are also specified.
PDF (68 KB)
Forms Property & Casualty
Proof Of Loss Medical Payment
A declaration by an insured person that itemizes payments made for medical services after an accident which qualify for medical expense coverage under the policy.
PDF (24 KB)
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 (28 KB)
Forms Property & Casualty