Notice Under Subrogation Rights (Spanish)
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (31 KB)
Forms Property & Casualty
Request For Copy Of Tax Return IRS Form 4506 (7/17)
IRS Form 4506 Request for Copy of Tax Return
PDF (43 KB)
Forms Property & Casualty
Automobile Accident/Loss Notice (Spanish)
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 (78 KB)
Forms Property & Casualty
Covenant Not To Sue
Thus is an agreement by an injured party to not pursue a lawsuit against another party in exchange for a settlement.
PDF (21 KB)
Forms Property & Casualty
Drivers Statement (Spanish)
A driver's written statement of sequence of events and collision information.
PDF (71 KB)
Forms Property & Casualty
PIP Application For Benefits (Spanish)
This application form to obtain personal injury protection benefits requests information regarding claimant's employment, income, injury, treatment dates and medical bills received, plus any loss of wages due to the accident.
PDF (45 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
Receipt & Release Medical Payments Coverage
This form is signed by those who qualify as insureds under a policy when collecting medical payments coverage. Used as both a receipt and a release.
PDF (21 KB)
Forms Property & Casualty
Nebraska WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Nebraska.
PDF (0 KB)
Forms Property & Casualty
Claimant's Report Of Accident (Spanish)
This report form is given to claimants to record the details of an accident. Includes accident location, property damage, vehicle occupants, witnesses and an accident diagram.
PDF (87 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
Inland Marine Proof Of Loss (Spanish)
Inland Marine Proof of Loss form is a legal document to be completed by an insured in support of a claim.
PDF (50 KB)
Forms Property & Casualty
Release & Trust Agreement (UM/UIM BI) (Spanish)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim. Requires the insured to cooperate in the recovery of funds from the responsible party.
PDF (65 KB)
Forms Property & Casualty
Certificate Of Satisfaction (Spanish)
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 (22 KB)
Forms Property & Casualty
