Insured's Release (Spanish)
The release form identifies all parties to a claim, states the date of the occurrence, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or action against the insurer for the claim event in question.
PDF (95 KB)
Forms Property & Casualty
Subrogation Receipt (Spanish)
A subrogation receipt is signed by the insured upon payment of a claim, and assigns the insurer to the right to recovery for the loss.
PDF (28 KB)
Forms Property & Casualty
Request For Transcript Of Tax Return IRS Form 4506-T (7/17)
IRS Form 4506-T Request for Transcript of Tax Return
PDF (44 KB)
Forms Property & Casualty
CEA 04A Endorsement Coverage for Breakables
A sample California Earthquake Authority (CEA) endorsement which provides a optional coverage to forms BEQ-3B, BEQ-3C, BEQ-6B, and BEQ-4B. Sold and serviced by participating insurance companies.
PDF (657.99 KB)
Policy Forms
Release And Trust Agreement (UM/UIM PD) (Spanish)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim involving property damage.
PDF (75 KB)
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 (25 KB)
Forms Property & Casualty
Denial - Less Than Deductible (Spanish)
A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
DOC (55 KB)
Letters
Release & Subrogation Receipt (Spanish)
A legal form signed by an insured acknowledging receipt of settlement and release of all subrogation rights to the insurer.
PDF (96 KB)
Forms Property & Casualty
Non-Waiver Agreement / Reservation Of Rights (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 (65 KB)
Forms Property & Casualty
Proof Of Loss (Mobile Home) (Spanish)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (67 KB)
Forms Property & Casualty
Statement As To Replacement Cost Coverage (Spanish)
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (35 KB)
Forms Property & Casualty
NFIP Adjuster's Final Report FEMA Form 086-0-14 (4/17)
This form is used by adjusters to document the overall flood damages to the insured's property and provide a detailed summary of the claims information.
PDF (512 KB)
Forms Flood
