Proof Of Loss (Mobile Home)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (50 KB)
Forms Property & Casualty
Automobile Arbitration Filing Form
An Arbitration Forums, Inc. form which is used by insurance companies when submitting an automobile claim for subrogation. Shows the Applicant and Respondent information, and includes a list of contentions setting forth the legal argument that the claim is owed with supporting evidence.
DOC (91 KB)
Forms Property & Casualty
Vehicle Bill Of Sale (Spanish)
The vehicle bill of sale is a document that records transaction between buyer and seller, identified by name and address. Bill of sale includes vehicle type, make, model, year, odometer reading, vehicle identification number (VIN) and purchase price.
PDF (26 KB)
Forms Property & Casualty
Adjuster Assignment Form - Fax
Generic fax form sent to an independent adjuster with details of a claim assignment. It allows for a full or limited assignment and lists specific actions required by the adjuster, such as loss verification, photos, scene diagram, statements, subrogation investigation, vehicle appraisals, and settlements.
DOC (33 KB)
Forms Property & Casualty
Automobile Accident/Loss Notice
A loss report form filled out by insureds and/or agents when reporting an automobile accident. Includes information on occupants, injuries, damages, accident description and witnesses.
PDF (65 KB)
Forms Property & Casualty
Emergency / Temporary Work Repair Summary
An emergency/temporary repair work order, including cost, provided in support of a property claim.
PDF (17 KB)
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 (12 KB)
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 (47 KB)
Forms Property & Casualty
Release And Trust Agreement (UM/UIM PD)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim involving property damage.
PDF (24 KB)
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 (46 KB)
Forms Property & Casualty
Reservation Of Rights Agreement
A reservation of insurer's rights to discovery, settlement, or defense in denial of a claim for loss and damages, agreed to by insured.
PDF (19 KB)
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 (33 KB)
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 (80 KB)
Forms Property & Casualty
Non-Auto Liability Accident Notice
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (40 KB)
Forms Property & Casualty
Schedule Of Contents (Spanish)
A contents inventory form, with columns to itemize place and date of purchase, cost, condition, actual value and amount claimed.
PDF (40 KB)
Forms Property & Casualty