Notice Of Loss Burglary-Robbery-Theft (Spanish)
A loss report form filled out by an insured when reporting a theft claim to and insurance company. Includes circumstances of the theft, and a list of items claimed as stolen with declared values.
PDF (80KB)
Property
Spanish
Forms Property & Casualty
Affidavit Of Vehicle Theft (Spanish)
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.
PDF (85KB)
Auto
Spanish
Forms Property & Casualty
Insured's Release (Spanish)
The release form identifies all parties to a claim, states the date of the occurrence, 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 action against the insurer for the claim event in question.
PDF (95KB)
Auto
Property
Spanish
Forms Property & Casualty
Power Of Attorney (Auto) (Spanish)
This is a limited power of attorney which grants the insurer permission to transfer title for a specific vehicle on the owner's behalf.
PDF (65KB)
Auto
Salvage
Spanish
Forms Property & Casualty
Reservation Of Rights Letter (Spanish)
The reservation of rights letter notifies the policyholder that the insurer reserves the right to deny coverage of a claim, in whole or part, pending outcome of a claims investigation.
DOC (57KB)
Auto
Liability
Property
Spanish
Special Investigations
Letters
Receipt & Release Medical Payments Coverage (Spanish)
This form is signed by those who qualify as insureds under a policy when collecting medical payments coverage. Used as both a receipt and a release.
PDF (25KB)
Liability
Spanish
Forms Property & Casualty
Hold Harmless Agreement (Spanish)
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 (82KB)
Auto
Liability
Property
Spanish
Workers' Compensation
Forms Property & Casualty
Release With Medical Agreement (Spanish)
This is a contract that releases an insurer from any legal and financial responsibility for injury and liability claims after a specified time period and medical expense settlement amount is agreed upon.
PDF (75KB)
Liability
Spanish
Forms Property & Casualty
Automobile Accident Promissory Note (Spanish)
Customized automobile subrogation promissory note which allows the insurance company to notify DMV/BMV in case of default by the tortfeasor.
PDF (56KB)
Auto
Liability
Spanish
Subrogation
Forms Property & Casualty
