Complete Release Of All Claims (Spanish)
A full release and indemnity agreement which is signed by claimants and releases insurer from bodily injury and property damage liability which arose out of an accident, casualty or event. The release form identifies all parties to a claim, states the date and location of the event, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer, or any other parties, for the event, and against the release.
PDF (95 KB)
Forms Property & Casualty
Request For Contact (Spanish)
Form letter requesting claimant to contact adjuster.
DOC (90 KB)
Letters
Subrogation Letter To Individual/Business (Spanish)
A subrogation letter sent to an at-fault party requests reimbursement for automobile losses paid to insured.
DOC (25 KB)
Letters
Release Of All Claims (Spanish)
A full release form which is signed by claimants and releases insureds from bodily injury and property damage liability which arose out of an accident, casualty or event. The release form identifies all parties to a claim, states the date and location of the event, and details the terms of settlement of a claim. The release contains a statement that, as a condition of the settlement, prevents any further claim or legal action against the insurer, or any other parties, for the event.
PDF (80 KB)
Forms Property & Casualty
Medical Authorization (HIPAA Compliant) (Spanish)
Authorization form for disclosure of medical records, in compliance with HIPAA requirements.
PDF (76 KB)
Forms Property & Casualty
Affidavit Of Salvage Retention (Spanish)
Acknowledgment by the current owner that his vehicle has been declared a total loss, and that he/she has elected to retain the salvage for a specific sum of monies. Towing and storage charges are also specified.
PDF (68 KB)
Forms Property & Casualty
Automobile Accident Report (Spanish)
Report form that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages and witnesses.
PDF (97 KB)
Forms Property & Casualty
PIP Application For Benefits (Spanish)
This application form to obtain personal injury protection benefits requests information regarding claimant's employment, income, injury, treatment dates and medical bills received, plus any loss of wages due to the accident.
PDF (45 KB)
Forms Property & Casualty
Notice Under Subrogation Rights (Spanish)
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (31 KB)
Forms Property & Casualty
Death Claims Investigation Checklist
A checklist helpful for establishing whether an insured is dead or alive, with research techniques to identify motives in possible cases of life insurance fraud.
PDF (51 KB)
General Reference
Claimant's Report Of Accident (Spanish)
This report form is given to claimants to record the details of an accident. Includes accident location, property damage, vehicle occupants, witnesses and an accident diagram.
PDF (87 KB)
Forms Property & Casualty
Automobile Accident/Loss Notice (Spanish)
A loss report form filled out by insureds and/or agents when reporting an automobile accident. Includes information on occupants, injuries, damages, accident description and witnesses.
PDF (78 KB)
Forms Property & Casualty
Denial - No Coverage (Spanish)
This form letter identifies the claimant, insurer, adjuster and date of loss; it is a claim denial for lack of coverage under the insured's policy.
DOC (45 KB)
Letters
Drivers Statement (Spanish)
A driver's written statement of sequence of events and collision information.
PDF (71 KB)
Forms Property & Casualty
