Claim Form Samples

Claim Forms

Title	Type	Size
Claim-Form-7A-fire-proof-of-loss-interim-2023	pdf	21 KB	Download
Claim-Form-5C-reservation-of-rights-letter-2001	pdf	10 KB	Download
Claim-Form-5B-medical-report-2001	pdf	21 KB	Download
Claim-Form-5A-authorization-wage-info-2001	pdf	10 KB	Download
Claim-Form-2E-notice-owner-branded-irreparable-2001	pdf	11 KB	Download
Claim-Form-6A-consent-to-settlement-2001	pdf	14 KB	Download
Claim-Form-3-final-release-2023	pdf	119 KB	Download
Claim-Form-2A-auto-total-loss-2023	pdf	144 KB	Download
Claim-Form-2B-disposition-salvage-2015	pdf	21 KB	Download
Claim-Form-2C-notice-owner-retained-salvage-2001	pdf	18 KB	Download
Claim-Form-2D-notice-owner-branded-salvage-2001	pdf	17 KB	Download
Claim-Form-2-auto-proof-of-loss-2023	pdf	116 KB	Download
Claim-Form-1-auto-accident-report-2015	pdf	43 KB	Download
Claim-Form-18-salvage-statement-2023	pdf	107 KB	Download
Claim-Form-12B-accident-benefits-medical-rpt-2023-draft	pdf	29 KB	Download
Claim-Form-17-auto-repair-invoicing-authorization-2023	pdf	130 KB	Download
Claim-Form-6B-agreem-by-insured-to-reimburse-authorize-insurer-2001	pdf	14 KB	Download
Claim-Form-7-fire-proof-of-loss-2023	pdf	133 KB	Download
Claim-Form-19-agreem-to-reimburse-recoverables-2023	pdf	115 KB	Download
Claim-Form-4-indemnifying-agreement-2023	pdf	117 KB	Download