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
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
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
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
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
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/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
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
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
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
PIP Application - Florida No Fault
Application form for Florida personal injury protection (PIP) No Fault benefits.
PDF (38 KB)
Forms Property & Casualty
Proof Of Loss (Mobile Home)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (50 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
Guidelines and Requested Data for Electrical Systems at Fire Scenes
A guide for fire scene investigation of electrical systems.
PDF (21 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
