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 (35KB)
Liability
Spanish
Forms Property & Casualty
Request For Medical Docs/Bills From Dr. (Spanish)
A form letter requesting medical documents and bills from a physician providing treatment to a claimant, sent with a medical authorization.
DOC (45KB)
Liability
Spanish
Workers' Compensation
Letters
Report Of Public Liability Accident (Spanish)
This report form provides notice and details of a public premise accident.
PDF (70KB)
Auto
Liability
Spanish
Forms Property & Casualty
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 (35KB)
Property
Spanish
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 (50KB)
Auto
Property
Spanish
Forms Property & Casualty
Statement Of Loss With Enclosures (Spanish)
An adjuster's statement of a loss using Schedules A, B & C, that includes enclosures.
PDF (50KB)
Property
Spanish
Forms Property & Casualty
Employer Occupational Injury And Disease Report (Spanish)
Basic reporting form used by an employer to record an employee's injury or illness on the job.
PDF (50KB)
Spanish
Workers' Compensation
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 (59KB)
Property
Spanish
Forms Property & Casualty
Emergency / Temporary Work Repair Summary (Spanish)
An emergency/temporary repair work order, including cost, provided in support of a property claim.
PDF (35KB)
Property
Spanish
Forms Property & Casualty
Notice Of Loss - Inland Marine (Spanish)
The inland marine notice of loss form describes the circumstances and amount of loss, and is prepared by an adjuster and presented to the insurer.
PDF (35KB)
Property
Spanish
Forms Property & Casualty
Statement Of Loss W/O Enclosures (Spanish)
An adjuster's statement of a loss using Schedules A, B & C.
PDF (55KB)
Property
Spanish
Forms Property & Casualty
