Non-Waiver Agreement / Reservation Of Rights (Spanish)
The non-waiver agreement is signed by the policyholder; its purpose is to protect the insurer. Insurer reserves all of its rights under the policy to investigate and defend a claim without admission of any liability for loss.
PDF (65 KB)
Forms Property & Casualty
Denial - Less Than Deductible (Spanish)
A denial letter used when the value of a claim submitted is determined to be less than the insured's deductible.
DOC (55 KB)
Letters
Statement As To Replacement Cost Coverage (Spanish)
A legal form stating the values used to calculate cost coverage for repair or replacement of a property loss.
PDF (35 KB)
Forms Property & Casualty
Affidavit-Lightning Losses (Spanish)
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.
PDF (50 KB)
Forms Property & Casualty
PIP Attending Physician's Report (Spanish)
The attending physician report form is used by an insurer to determine if a person is due benefits under personal injury protection (PIP) law.
PDF (55 KB)
Forms Property & Casualty
PIP Wage & Salary Verification (Spanish)
This form is used to verify wage and salary information of a person who has applied for personl injury protection (PIP) benefits after an automobile accident.
PDF (35 KB)
Forms Property & Casualty
Automobile Proof Of Loss (Spanish)
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.
PDF (86 KB)
Forms Property & Casualty
Corporation Release (Spanish)
A release and indemnity agreement for a corporation, which releases insurer from 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.
PDF (45 KB)
Forms Property & Casualty
Reservation Of Rights Agreement (Spanish)
A reservation of insurer's rights to discovery, settlement, or defense in denial of a claim for loss and damages, agreed to by insured.
PDF (92 KB)
Forms Property & Casualty
General Release (Husband & Wife) (Spanish)
A legal form that absolves an insurer from any further liability for a claim upon acceptance of a settlement amount by a married couple.
PDF (105 KB)
Forms Property & Casualty
