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 (92KB)
Forms Property & Casualty
Report Of Public Liability Accident (Spanish)
This report form provides notice and details of a public premise accident.
PDF (70KB)
Forms Property & Casualty
Automobile Accident/Loss Notice (Spanish)
A loss report form filled out by insureds and/or agents when reporting an automobile accident. Includes information on occupants, injuries, damages, accident description and witnesses.
PDF (78KB)
Forms Property & Casualty
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)
Forms Property & Casualty
Memorandum For Appraisal (Spanish)
Memorandum for Appraisal is used in property damage situations where insured and insurer disagree on actual cash value, and is binding on the parties as to the amount of loss.
PDF (60KB)
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)
Forms Property & Casualty
Passengers Statement (Spanish)
A passenger's statement describes persons, vehicles, injuries, driver actions and circumstances of a crash.
PDF (85KB)
Forms Property & Casualty
Proof Of Loss (Burglary) (Spanish)
A sworn statement by a policyholder on a theft claim which lists the items stolen and their values. Filled out and notarized, this is a formal request by the insured for payment from the insurance company.
PDF (94KB)
Forms Property & Casualty
Attending Physician's Report (Spanish)
A form which is filled out by the attending physician in order to qualify for medical benefits under an automobile insurance policy. (Spanish version of English form 3160F)
PDF (80KB)
Forms Property & Casualty
Covenant Not To Sue (Spanish)
Thus is an agreement by an injured party to not pursue a lawsuit against another party in exchange for a settlement.
PDF (40KB)
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 (105KB)
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 (35KB)
Forms Property & Casualty
