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 (59 KB)
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 (20 KB)
Forms Property & Casualty
Statement Of Loss W/O Enclosures
An adjuster's statement of a loss using Schedules A, B & C.
PDF (51 KB)
Forms Property & Casualty
Memorandum For Appraisal
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 (35 KB)
Forms Property & Casualty
Denial - Less Than Deductible
A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
DOC (17 KB)
Letters
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 (19 KB)
Statement Guides
Statement As To Replacement Cost Coverage
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (26 KB)
Forms Property & Casualty
Living/Family Room Diagram
This Microsoft Word template allows users to add and resize a variety of objects including walls, windows, couches, chairs, and tables.
DOC (68 KB)
Diagrams
Coinsurance Definition And Formula
Coinsurance formula and sample calculation for a property claim where the insured did not maintain the required minimum coverage (usually 80% of value) on a structure.
PDF (38 KB)
General Reference
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 (36 KB)
Forms Property & Casualty
Adjuster's File Invoice
An invoice form used by independent adjusting firms that lists claims investigation expenses billable to the client insurance company.
PDF (48 KB)
Forms Property & Casualty
Subrogation Receipt
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 (27 KB)
Forms Property & Casualty
Claim Register Sheet
Basic registry form for logging when claims are received and closed.
PDF (83 KB)
Forms Property & Casualty
Property Arbitration Contentions Sheet
A property subrogation arbitration form.
DOC (28 KB)
Forms Property & Casualty
