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
Passengers Statement (Spanish)
A passenger's statement describes persons, vehicles, injuries, driver actions and circumstances of a crash.
PDF (85KB)
Auto
Liability
Spanish
Forms Property & Casualty
Medical Authorization (HIPAA Compliant) (Spanish)
Authorization form for disclosure of medical records, in compliance with HIPAA requirements.
PDF (76KB)
Liability
Spanish
Workers' Compensation
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
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
Notice Under Subrogation Rights (Spanish)
Claim form used to notify an individual of subrogation rights of an insurer for an auto insurance loss.
PDF (31KB)
Auto
Liability
Spanish
Subrogation
Forms Property & Casualty
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
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
Automobile Accident Report - NY (Spanish)
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.
PDF (55KB)
Auto
Liability
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
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 (68KB)
Auto
Salvage
Spanish
Forms Property & Casualty
Certificate Of Satisfaction (Spanish)
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 (22KB)
Auto
Liability
Property
Spanish
Forms Property & Casualty
