Documents » 4-Column Adjusters Worksheet
Generic worksheet with one column for text detail and 4 columns for numeric calculation. Download File
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Form 2030F
© 2003 Nationwide Publishing Company, Inc.
http://www.claimspages.com
SUBROGATION RECEIPT
RECEIVED FROM (Hereinafter referred to as “Company”)
THE SUM OF DOLLARS ($)
as a loan, without interest, repayable only in the event and to the extent of any net recovery the undersigned may make from
any person, persons, corporations,... | Form 2040F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
STATEMENT AS TO FULL COST OF REPAIR OR REPLACEMENT
UNDER THE REPLACEMENT COST COVERAGE
SUBJECT TO THE TERMS AND CONDITIONS OF THIS POLICY
To the Ins. Co.
of Policy No..
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Location.
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Form 2020F
© 2003 Nationwide Publishing Company, Inc.
http://www.claimspages.com
RELEASE & SUBROGATION RECEIPT
RECEIVED FROM (Hereinafter referred to as “Company”)
THE SUM OF DOLLARS ($)
in full payment, release and discharge of all claims and demands of the undersigned against the said Company, arising from
or connected with any... | Form used by service providers to obtain direct payment for a loss. The owner of the damaged property signs the form which certfies his/her satisfaction and instructs the insurance company to make direct payment to the service provider. | |
Form 1210F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
.
PROOF OF LOSS (AIRCRAFT)
Make and Type Gov. I.D. No. When Seating ENGINES
Airplane, Seaplane, Flying Boat Mfrs. Serial No. Constructed Cap. H.P. Type I.D. Year
Coverage: Against the perils of
Description: Aloss occurred on the day of ,
20 about the... | Form 1170F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
.
SWORN STATEMENT IN PROOF OF LOSS (MOBILE HOME)
Name of Insured:
Policy No. Date of Loss:
Amount Claimed $ Time of Loss: M.
DESCRIPTION OF INSURED MOBILE HOME OR RECREATIONAL VEHICLE
INSURED PERSONAL EFFECTS…………………………………………$
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Guidelines and Requested Data for Electrical Systems at Fire Scenes
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Please spend a few minutes to document how you found the system and what was done. This information may
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1. Safety First! These guidelines are in addition to all... | |
Form 2140F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
STATEMENT OF LOSS
Schedule “A”
Policy Form: Agency:
Date of Loss: File Number:
Item $ on
Item $ on
Item $ on
Item $ on
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COINSURANCE, DISTRIBUTION, DEDUCTIBLE CLAUSE
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<------------LEFT SIDE OF PANEL------------------ ----------------RIGHT SIDE OF PANEL--------------
Written info/notes/ wire
size/color
Status
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Amp
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Pos... | |
Form 2660F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
INSURED’S STATEMENT AND CLAIM FORM (THEFT-BURGLARY LOSS)
Name: Telephone Number:
Address: City: State: Zip Code:
Occupation: Spouse’s Occupation:
Employer: Spouse’s Employer:
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Theft From: PRIVATE DWELLING AUTO APARTMENT... | Home Inventory Checklist
Maintaining a room-by-room inventory of
your personal property can be extremely
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Your... | |
An ACORD form for calculating the replacement cost of a residential dwelling using the Boeckh square foot method. This form is used by insurance agents to determine how much coverage should be written when an application is submitted, and by insurance claims adjusters after a loss when checking the adequacy of coverage per the coinsurance clause. | Digital Photo Sheet 2 | |
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. | Form 2300F
© 2004 Nationwide Publishing Company, Inc.
http://www.claimspages.com
PROPERTY LOSS WORKSHEET
Claim Number: Insured:
Claimant: Adjuster:
Preliminary Estimate: $ Final Estimate: $
1 2 3 4 5 6 7 8 9
ITEM DESCRIPTION QUANTITY UNITS PRICE COST
AGE ORG. COST REP.COST DEPREC. A.C.V. LOSS -DAMAGE
INSTRUCTIONS-Columns 4-9, unshaded... | |
The Adjusters Report/Certification form is similar to form 2110F but includes more detail regarding structural, contents and additional living expense payment recommendations. The adjuster certifies the loss and requests payment with this form. | Create your own time line using this Microsoft Excel template. Just enter dates and labels. |
