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.
This legal form must be filled out by the insured and notarized. Includes information on vehicle ownership, description & condition, financing, as well as details regarding the theft and police report.
This affidavit is filled out by a service provider who inspects a property and certifies lightning damage as the sole source of the loss. A notorized signature and witnesses are required.
A form which is filled out by the attending physician in order to qualify for medical benefits under an automobile insurance policy. (Spanish version of English form 3160F)
Customized automobile subrogation promissory note which allows the insurance company to notify DMV/BMV in case of default by the tortfeasor.
Report form, customized for New York, that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages, crash diagram, driver's account of accident, and witnesses.
Report form that is given to vehicle owners and drivers to capture the details of an accident. Includes occupants, injuries, property damages and witnesses.
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.
A policyholder must provide this sworn statement in support of an automobile claim. The notarized form documents the date and cause of loss, vehicle identification, settlement amount, and reserves subrogation and other rights of the insurer.
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.