Property Insurance Claims Documents (Page 4)

Structural Fire - Witness

Statement guideline for interviewing a witness to a structural fire. Includes initial questions and follow up questions based on responses given.

PDF (19KB) Property Statement Guides

Release & Authorization Of Payment

Used as a general release form which is signed by insureds and specifies payment to settle a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer for the loss event.

PDF (26KB) Auto Liability Property 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) Property Forms Property & Casualty

4 Column Adjuster Worksheet

Financial worksheet for calculating a repair estimate, with one column to itemize losses, and 4 columns for replacement cost, quantity or age, depreciation, and actual cash value.

PDF (79KB) Auto Management & Underwriting Property Forms Property & Casualty

Customer's Claim & Affidavit

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 (59KB) Liability Property Forms Property & Casualty

Non-Waiver Agreement / Reservation Of Rights

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 (36KB) Auto Liability Property Workers' Compensation Forms Property & Casualty

Receipt For Advance Payment

PDF (23KB) Auto Liability Property Workers' Compensation Forms Property & Casualty

Inland Marine Proof Of Loss

Inland Marine Proof of Loss form is a legal document to be completed by an insured in support of a claim.

PDF (33KB) Property Forms Property & Casualty

Hold Harmless Agreement

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 (20KB) Liability Property Forms Property & Casualty

Notice Of Loss Burglary-Robbery-Theft

A loss report form filled out by an insured when reporting a theft claim to an insurance company. Includes circumstances of the theft, and a list of items claimed as stolen with declared values.

PDF (47KB) Property Forms Property & Casualty