Drivers Statement (Spanish)
A driver's written statement of sequence of events and collision information.
PDF (71 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
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 (22 KB)
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 (82 KB)
Forms Property & Casualty
Inland Marine Proof Of Loss (Spanish)
Inland Marine Proof of Loss form is a legal document to be completed by an insured in support of a claim.
PDF (50 KB)
Forms Property & Casualty
Release & Trust Agreement (UM/UIM BI) (Spanish)
A release form signed by an insured when making an uninsured motorist or underinsured motorist claim. Requires the insured to cooperate in the recovery of funds from the responsible party.
PDF (65 KB)
Forms Property & Casualty
Notice Of Plate Glass Loss (Spanish)
The notice of plate glass loss details the circumstances and description of loss. Included is an estimate for lowest replacement cost by a glazier.
PDF (59 KB)
Forms Property & Casualty
Claim Acknowledgement Letter (Spanish)
A basic MS Word template letter sent as a best practice for the protection of all parties involved. The letter acknowledges receipt of the claim and requests contact with the insured or claimant.
DOC (51 KB)
Letters
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 (55 KB)
Forms Property & Casualty
Guarantee Of Title (Spanish)
For a case involving a total loss or theft of a financed motor vehicle or boat, this is an agreement that the lien holder will provide a lien free Certificate of Title to the insurance company upon receipt of a claim payment.
PDF (20 KB)
Forms Property & Casualty
Employment, Wage & Med. Authorization (Spanish)
An employee authorization form allowing release of employment, wage and medical information to another party.
PDF (85 KB)
Forms Property & Casualty
Request For Accident Report (Spanish)
Form letter used by an adjuster requesting an accident report.
DOC (39 KB)
Letters
