Certificate Of Satisfaction
The insured signs this form which certfies his/her satisfaction with damage repairs performed, directs claim payment to that service provider, and closes the claim.
PDF (25KB)
Auto
Property
Forms Property & Casualty
Emergency / Temporary Work Repair Summary
An emergency/temporary repair work order, including cost, provided in support of a property claim.
PDF (17KB)
Property
Forms Property & Casualty
Reservation Of Rights Agreement
A reservation of insurer's rights to discovery, settlement, or defense in denial of a claim for loss and damages, agreed to by insured.
PDF (19KB)
Auto
Liability
Property
Special Investigations
Workers' Compensation
Forms Property & Casualty
Proof Of Loss (Mobile Home)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (50KB)
Property
Forms Property & Casualty
NFIP Adjuster Certification Application FEMA Form 086-0-21 (4/17)
This form is used to collect information from individuals seeking to become certified flood adjusters.
PDF (453KB)
Catastrophe
Property
Forms Flood
Daily Time Sheet
A daily time sheet to record claims work, hours, mileage and expenses.
PDF (91KB)
Auto
Liability
Property
Workers' Compensation
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 (25KB)
Property
Forms Property & Casualty
Adjuster Preliminary Flood Damage Assessment FEMA Form 086-0-20 (4/17)
This form is used by adjusters to list potentially substantial damaged structures in preparation for possible ICC claims.
PDF (229KB)
Catastrophe
Property
Forms Flood
Notice of Loss FEMA Form 086-0-11 (4/17)
This form allows insurance agents or brokers to document damages caused by flood-related hazards to structures covered by the National Flood Insurance Program.
PDF (416KB)
Catastrophe
Property
Forms Flood
Request For Copy Of Tax Return IRS Form 4506 (7/17)
IRS Form 4506 Request for Copy of Tax Return
PDF (43KB)
Auto
Liability
Property
Workers' Compensation
Forms Property & Casualty
Adjuster's Loss Certification and Apportionment of Claim
This form is used to recommend to the insurer the amount of payment for a loss, and apportionment when a property is covered by two or more insurance companies.
PDF (21KB)
Liability
Property
Forms Property & Casualty
