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
Drivers Statement (Spanish)
A driver's written statement of sequence of events and collision information.
PDF (71KB)
Forms Property & Casualty
Denial - No Coverage (Spanish)
This form letter identifies the claimant, insurer, adjuster and date of loss; it is a claim denial for lack of coverage under the insured's policy.
DOC (45KB)
Letters
Kentucky - Uniform Police Traffic Collision Report: KSP 74 (1/00)
The Kentucky Uniform Police Traffic Collision Report includes vehicle and driver information, collision circumstances, a crash diagram and crash narrative.
PDF (705KB)
Crash Reports
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
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
Georgia - Uniform Vehicle Accident Report Overlay: DOT-523 Overlay
Code sheet used to decipher the Vehicle Accident Report for Georgia.
PDF (48KB)
Crash Reports
Accident Scene Diagram - Railroad Intersection
This Microsoft Word template allows users to sketch an accident scene by adding and resizing a variety of objects including roads, vehicles, traffic signs, road signals and other symbols and figures in a railroad intersection.
DOC (2152KB)
Diagrams
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
Automobile Accident Report - NY
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 (71KB)
Forms Property & Casualty
South Carolina - Accident and Insurance Inquiry Forms (Financial Responsibility)
South Carolina Department of Motor Vehicles Accident and Insurance Inquiry forms relating to Financial Responsibility.
PDF (251KB)
Forms Property & Casualty
