Claims Pages
claimspages

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

PIP Application - Florida No Fault

Application form for Florida personal injury protection (PIP) No Fault benefits.
  PDF (38 KB) Forms Property & Casualty

Minnesota WC Forms

A collection of workers' compensation forms which are authorized to be used in the state of Minnesota.
  PDF (0 KB) Forms Property & Casualty


Report Of Public Liability Accident

This report form provides notice and details of a public premise accident.
  PDF (40 KB) Forms Property & Casualty

Customer's Claim & Affidavit (Spanish)

Damage to customer's property is included under a commercial general liability policy; this form describes items lost, seller, purchase date and depreciation. The claim amount is submitted with signature of customer and adjuster.
  PDF (61 KB) 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 (32 KB) Forms Property & Casualty

Arizona Workers' Compensation Forms

A collection of workers' compensation forms which are authorized to be used in the state of Arizona.
  PDF (0 KB) Forms Property & Casualty

Vehicle Repair Order

Agreement and authorization between insured and automotive shop to repair a damaged vehicle within the estimated dollar amount.
  PDF (15 KB) Forms Property & Casualty

Proof Of Loss (Aircraft)

A Proof of Loss form for an insurance claim involving an aircraft.
  PDF (43 KB) 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 (82 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

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


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