Claims Pages
claimspages

Automobile Accident Promissory Note (Spanish)

Customized automobile subrogation promissory note which allows the insurance company to notify DMV/BMV in case of default by the tortfeasor.
  PDF (56KB) Forms Property & Casualty

Property Loss Worksheet (Spanish)

Use this worksheet to inventory property and content losses, and obtain an estimate of replacement costs. It contains columns to factor in age, original cost, replacement cost and depreciation to calculate ACV (actual cash value).
  PDF (91KB) 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 (65KB) 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 (87KB) Forms Property & Casualty

Wisconsin WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Wisconsin.
  PDF (0KB) 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

Drivers Statement (Spanish)

A driver's written statement of sequence of events and collision information.
  PDF (71KB) 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 (45KB) 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

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

Proof Of Loss (Aircraft)

A Proof of Loss form for an insurance claim involving an aircraft.
  PDF (43KB) 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

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

Monty Fire Investigations LLCSeekNowKelmar Global