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)
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 (55KB)
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)
Forms Property & Casualty
Proof Of Loss (Aircraft) (Spanish)
A Proof of Loss form for an insurance claim involving an aircraft.
PDF (41KB)
Forms Property & Casualty
Employment-Wage Authorization (Spanish)
A person uses this form to authorize an employer to release his or her employment and wage records to a third party.
PDF (86KB)
Forms Property & Casualty
Proof Of Loss (Mobile Home) (Spanish)
A legal form documenting a claimant's property loss involving a mobile home.
PDF (67KB)
Forms Property & Casualty
General Authorization (Spanish)
This form authorizes release of information, and requires a notary signature.
PDF (85KB)
Forms Property & Casualty
Release With Medical Agreement (Spanish)
This is a contract that releases an insurer from any legal and financial responsibility for injury and liability claims after a specified time period and medical expense settlement amount is agreed upon.
PDF (75KB)
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 (20KB)
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
Reservation Of Rights Letter (Spanish)
The reservation of rights letter notifies the policyholder that the insurer reserves the right to deny coverage of a claim, in whole or part, pending outcome of a claims investigation.
DOC (57KB)
Letters
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
