 |
AUTO/CASUALTY FORMS |
|
| Form# |
Description |
Price Group |
| A-101 |
RECEIPT AND RELEASE MEDICAL PAYMENTS COVERAGE |
3 |
| A-102 |
POWER OF ATTORNEY |
3 |
| A-103 |
AFFIDAVIT OF SALVAGE RETENTION |
3 |
| A-125 |
PROOF OF LOSS MEDICAL EXPENSE |
3 |
| A-126 |
RELEASE — UNINSURED/ UNDERINSURED MOTORISTS PROTECTION COVERAGE |
3 |
| A-127 |
NOTICE UNDER SUBROGATION RIGHTS |
3 |
| A-128 |
BILL OF SALE – AUTOMOBILE |
3 |
| A-129 |
AUTOMOBILE IDENTIFICATION |
3 |
| A-130 |
PASSENGER'S STATEMENT |
3 |
| A-131 |
SWORN STATEMENT IN PROOF OF LOSS (AUTOMOBILE)
|
3 |
| A-133 |
AUTOMOBILE ACCIDENT OR LOSS NOTICE |
3 |
| A-136 |
AUTOMOBILE EVALUATION SHEET |
3 |
| A-151 |
AUTOMOBILE SWORN STATEMENT IN PROOF OF LOSS |
3 |
| A-152 |
AUTOMOBILE ACCIDENT REPORT |
3 |
| A-156 |
CLAIMANT'S REPORT OF ACCIDENT (AUTO) |
3 |
| A-157 |
INSTALLMENT AGREEMENT |
3 |
| A-158 |
STATEMENT OF DRIVER |
3 |
| A-159 |
WITNESS REPORT OF ACCIDENT (AUTOMOBILE) |
3 |
| A-160 |
AIRCRAFT HULL — STATEMENT IN PROOF OF LOSS |
3 |
| A-160 |
APPLICATION FOR TEXAS CERTIFICATE OF TITLE |
3 |
| A-164 |
ATTENDING PHYSICIAN'S REPORT |
3 |
| A-165 |
AFFIDAVIT OF VEHICLE THEFT |
3 |
| A-180T |
APPLICATION FOR BENEFITS - AUTOMOBILE PERSONAL INJURY PROTECTION (TEXAS) |
14b |
| A-181 |
APPLICATION FOR BENEFITS - AUTOMOBILE PERSONAL INJURY PROTECTION |
14b |
|
PROPERTY |
|
| F-125 |
TEXAS HOMEOWNER POLICY (SWORN PROOF OF LOSS) - NOT A RELEASE |
3 |
| F-126 |
RELEASE AND SUBROGATION RECEIPT |
3 |
| F-127 |
SUBROGATION RECEIPT |
3 |
| F-128 |
STATEMENT AS TO FULL COST OF REPAIR OR REPLACEMENT |
3 |
| F-129 |
RELEASE AND AUTHORIZATION OF PAYMENT |
3 |
| F-130 |
NON-WAIVER AGREEMENT |
3 |
| F-132 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-134 |
ADJUSTER'S CERTIFICATION - STATEMENT OF LOSS |
3 |
| F-135 |
PROOF OF HEIRSHIP |
3 |
| F-137 |
STATEMENT OF ACTUAL CASH VALUE AND LOSS AND DAMAGE |
3 |
| F-138 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-139 |
PROOF OF LOSS PERSONAL MEDICAL PAYMENTS |
3 |
| F-140 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-141 |
MASTER PROOF OF LOSS |
3 |
| F-142 |
CUSTOMER'S CLAIM AND AFFADAVIT — LOSS OR DAMAGE
|
3 |
| F-143 |
BUILDING REPAIR ESTIMATE |
3 |
| F-144 |
SCHEDULE OF CONTENTS |
3 |
| F-145 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-146 |
ADJUSTER'S REPORT/CERTIFICATION |
3 |
| F-147 |
ACKNOWLEDGEMENT OF ASSIGNMENT AND PRELIMINARY REPOR |
3 |
| F-148 |
AFFIDAVIT — LIGHTNING LOSSES |
3 |
| F-149 |
ADJUSTER'S STATUS REPORT |
3 |
| F-151 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-152 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-153 |
RULED FORM (3 COLUMN) |
3 |
| F-154 |
RULED FORM (4 COLUMN) |
3 |
| F-155 |
PROPERTY LOSS WORKSHEET |
3 |
| F-156 |
NON-WAIVER AGREEMENT |
3 |
| F-158 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-159 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-160 |
LIVESTOCK — STATEMENT IN PROOF OF LOSS |
3 |
| F-161 |
INLAND MARINE PROOF OF LOSS |
3 |
| F-164 |
NOTICE OF LOSS—BURGLARY—ROBBERY—THEFT (SHORT FORM)
|
3 |
| F-165 |
PARKINGPROOF OF LOSS BURGLARY, THEFT, LARCENY, ROBBERY (SHORT FORM) |
3 |
| F-166B |
SCHEDULE OF CONTENTS |
3 |
| F-167 |
LIABILITY ACCIDENT NOTICE (NON - AUTOMOBILE) |
3 |
| F-168 |
PROOF OF LOSS (Burglary, Robbery, Theft, Larceny, Disappearance) |
3 |
| F-169 |
SWORN STATEMENT IN PROOF OF LOSS |
3 |
| F-175 |
MEMORANDUM FOR APPRAISAL |
6B |
| F-178 |
AGREEMENT FOR SUBMISSION TO APPRAISERS |
6B |
| F-179 |
SWORN STATEMENT IN PROOF OF LOSS (For Use With Replacement Cost Coverages) |
6B |
|
LIABILITY/RELEASE |
|
| L-101 |
MEDICAL AUTHORIZATION |
3 |
| L-102 |
NON–INJURY STATEMENT |
3 |
| L-103 |
NON-INJURY STATEMENT — A MINOR |
3 |
| L-104 |
EMPLOYMENT & WAGE AUTHORIZATION |
3 |
| L-106 |
AUTHORIZATION |
3 |
| L-125 |
RELEASE OF ALL CLAIMS |
3 |
| L-126 |
RELEASE OF ALL CLAIMS |
3 |
| L-127 |
PARENTS-GUARDIAN RELEASE AND INDEMNITY AGREEMENT |
3 |
| L-128 |
|
3 |
| L-130 |
COVENANT NOT TO SUE |
3 |
| L-131 |
RESERVATION OF RIGHTS AGREEMENT
|
3 |
| L-132 |
|
3 |
| L-133 |
GENERAL RELEASE, HUSBAND AND WIFE
|
3 |
| L-134 |
ATTENDING PHYSICIAN'S REPORT |
3 |
| L-135 |
INFORMATION SHEET |
3 |
| L-136 |
|
3 |
| L-137 |
RELEASE AND INDEMNITY AGREEMENT
|
3 |
| L-138 |
|
3 |
| L-139 |
RELEASE WITH MEDICAL AGREEMENT
|
3 |
| L-140 |
RELEASE OF ALL CLAIMS |
3 |
| L-141 |
RECEIPT FOR ADVANCE PAYMENT (THIS IS NOT A RELEASE)
|
3 |
| L-144 |
EMPLOYMENT & WAGE AUTHORIZATION |
3 |
| L-150 |
MEDICAL REPORT |
3 |
| L-154 |
|
3 |
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TWCC FORMS IN STOCK!
Call for more info at 1-800-527-0340.
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| TWCC13 |
COMPROMISE SETTLEMENT AGREEMENT TWCC 13
|
8 |