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
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
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 (22KB)
Forms Property & Casualty
Passengers Statement (Spanish)
A passenger's statement describes persons, vehicles, injuries, driver actions and circumstances of a crash.
PDF (85KB)
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
Non-Waiver Agreement (Spanish)
The non-waiver agreement is signed by the policyholder; its purpose is to protect the insurer. Insurer reserves all of its rights under the policy to investigate and defend a claim without admission of any liability for loss.
PDF (82KB)
Forms Property & Casualty
Automobile Accident Report - NY (Spanish)
Report form, customized for New York, that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages, crash diagram, driver's account of accident, and witnesses.
PDF (55KB)
Forms Property & Casualty
Witness Statement (Spanish)
This written statement is prepared by an accident witness. It documents all details they can recall about the accident scene, including any statements made by parties involved.
PDF (95KB)
Forms Property & Casualty
PIP Attending Physician's Report
The attending physician report form is used by an insurer to determine if a person is due benefits under personal injury protection (PIP) law.
PDF (55KB)
Forms Property & Casualty
Non-Auto Liability Accident Notice
Non- auto liability accident notice form details personal injuries and accident circumstances.
PDF (40KB)
Forms Property & Casualty
Notice Of Loss - Inland Marine
The inland marine notice of loss form describes the circumstances and amount of loss, and is prepared by an adjuster and presented to the insurer.
PDF (25KB)
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 (21KB)
Forms Property & Casualty
