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

Adjuster's File Invoice

An invoice form used by independent adjusting firms that lists claims investigation expenses billable to the client insurance company.
  PDF (48KB) Auto Liability Property Workers' Compensation Forms Property & Casualty

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

Sworn Statement In Proof Of Loss (w/Subrogation)

A notarized statement of the money claimed for a loss under a property coverage policy, which includes giving insurer the right to recovery.
  PDF (94KB) Ocean Marine Property Subrogation 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

Adjusters Report/Certification

The Adjusters Report/Certification documents the insured property's location, date and type of loss, and summarizes replacement cost and A.C.V. for buildings, structural, contents and additional living expense, with line item detail.
  PDF (47KB) 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

Statement Of Loss With Enclosures

An adjuster's statement of a loss using Schedules A, B & C, that includes enclosures.
  PDF (61KB) Property 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 (27KB) Auto Liability Ocean Marine Property Forms Property & Casualty

Acknowledgement Of Assignment

Generic form used by independent adjusters to acknowledge receipt of a property insurance claim, and provide a preliminary report to the insurance company.
  PDF (23KB) Auto Liability Property Workers' Compensation Forms Property & Casualty

Proof Of Loss (Burglary)

A sworn statement by a policyholder on a theft claim which lists the items stolen and their values. Filled out and notarized, this is a formal request by the insured for payment from the insurance company.
  PDF (46KB) Property Forms Property & Casualty

Property Arbitration Contentions Sheet

A property subrogation arbitration form.
  DOC (28KB) Property Subrogation Forms Property & Casualty

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