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 (68KB)
Forms Property & Casualty
Hold Harmless Agreement (Spanish)
This is a contract that releases one party from any legal and financial responsibility for all loss or damage or future claims by the other party in exchange for a settlement.
PDF (82KB)
Forms Property & Casualty
Affidavit Of Vehicle Theft (Spanish)
This legal form must be filled out by the insured and notarized. Includes information on vehicle ownership, description & condition, financing, as well as details regarding the theft and police report.
PDF (85KB)
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 (24KB)
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 (33KB)
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 (21KB)
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 (19KB)
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 (91KB)
Forms Property & Casualty
Request For Copy Of Tax Return IRS Form 4506 (7/17)
IRS Form 4506 Request for Copy of Tax Return
PDF (43KB)
Forms Property & Casualty
Notice Under Subrogation Rights (Spanish)
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (31KB)
Forms Property & Casualty
Texas Limited POA For Eligible Motor Vehicle Transactions VTR-271 (8/17)
This document gives the insurance company legal authority to transfer title of a vehicle that has been declared a total loss, and sell it for salvage.
PDF (24KB)
Forms Property & Casualty
Uninsured Motorist Arbitration Filing Form
An arbitration request form for a disagreement involving an uninsured motorist that includes allegations, contentions and supporting evidence.
DOC (37KB)
Forms Property & Casualty
Proof Of Loss (Medical Expense)
A declaration by an insured person that he/she was not being transported for a fee at the time of the accident, and otherwise qualifies for medical expense coverage under the policy.
PDF (32KB)
Forms Property & Casualty
Pennsylvania WC Forms
A collection of workers' compensation forms which are authorized to be used in the state of Pennsylvania.
PDF (0KB)
Forms Property & Casualty
