Special Arbitration Filing Form
The special arbitration form identifies the parties and allegations involved in a dispute, and lists supporting evidence.
DOC (52KB)
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)
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 (26KB)
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 (26KB)
Forms Property & Casualty
Notice Of Loss Burglary-Robbery-Theft
A loss report form filled out by an insured when reporting a theft claim to an insurance company. Includes circumstances of the theft, and a list of items claimed as stolen with declared values.
PDF (47KB)
Forms Property & Casualty
Emergency / Temporary Work Repair Summary
An emergency/temporary repair work order, including cost, provided in support of a property claim.
PDF (17KB)
Forms Property & Casualty
Property Arbitration Filing Form
A property subrogation arbitration form.
DOC (55KB)
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)
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)
Forms Property & Casualty
Employment-Wage Authorization
A person uses this form to authorize an employer to release his or her employment and wage records to a third party.
PDF (12KB)
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)
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 (97KB)
Forms Property & Casualty
Release Of All Claims (Spanish)
A full release form which is signed by claimants and releases insureds 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.
PDF (80KB)
Forms Property & Casualty
