Claims Pages
claimspages

Emergency / Temporary Work Repair Summary (Spanish)

An emergency/temporary repair work order, including cost, provided in support of a property claim.
  PDF (35KB) Forms Property & Casualty

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 (96KB) Forms Property & Casualty

Notice Of Plate Glass Loss (Spanish)

The notice of plate glass loss details the circumstances and description of loss. Included is an estimate for lowest replacement cost by a glazier.
  PDF (59KB) Forms Property & Casualty

Livestock Proof Of Loss

A livestock Proof of Loss and settlement document.
  PDF (50KB) Forms Property & Casualty


Notice Of Plate Glass Loss

The notice of plate glass loss details the circumstances and description of loss. Included is an estimate for lowest replacement cost by a glazier.
  PDF (35KB) 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 (35KB) Forms Property & Casualty

Affidavit-Lightning Losses (Spanish)

This affidavit is filled out by a service provider who inspects a property and certifies lightning damage as the sole source of the loss. A notorized signature and witnesses are required.
  PDF (50KB) Forms Property & Casualty

Memorandum For Appraisal (Spanish)

Memorandum for Appraisal is used in property damage situations where insured and insurer disagree on actual cash value, and is binding on the parties as to the amount of loss.
  PDF (60KB) Forms Property & Casualty

Sworn Statement In Proof Of Loss (w/Subrogation) (Spanish)

A notarized statement of the money claimed for a loss under a property coverage policy, which includes giving insurer the right to recovery.
  PDF (75KB) Forms Property & Casualty



Statement Of Loss With Enclosures (Spanish)

An adjuster's statement of a loss using Schedules A, B & C, that includes enclosures.
  PDF (50KB) Forms Property & Casualty

Insured's Statement In Burglary Loss (Spanish)

A written statement by the insured detailing a burglary loss claim involving a residence or automobile.
  PDF (55KB) Forms Property & Casualty
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