Form Number |
Name/Description |
1 |
Property Loss Notice |
2 |
Automobile Loss Notice |
3 |
General Liability Notice of Occurrence/Claim |
4 |
Workers Comp First Report of Injury or Illness |
11 |
Auto Accident Information Form |
12 |
Exchange of Information Form |
13 |
Witness Card |
18 |
Jewelry Appraisal and Claim Evaluation |
23 |
Leased Auto Certificate of Insurance |
24 |
Certificate of Property Insurance |
25-S |
Certificate of Liability Insurance |
25-N |
Certificate of Liability Insurance |
26 |
Policy Certification Log |
27 |
Evidence of Property Insurance |
35 |
Cancellation Request/Policy Release |
36 |
Agent/Broker of Record Change |
37 |
Statement of No Loss |
38 |
Notice of Information Practices (Privacy) |
40 |
Residential Property Valuation Survey |
41 |
Residential Property Replacement Cost Worksheet |
42 |
Residential Property Replacement Cost Information Supplement |
45 |
Additional Interest |
50 |
Insurance Identification Card |
50-WM |
Insurance Identification Card (With Watermark) |
54 |
Financial Responsibility Form |
57 |
Financial Responsibility Form (Notice of Cancellation or Termination) |
60 |
Flood Insurance Notice/Rejection |
63 |
General Fraud Statement |
67 |
IL- IN- KY- WV Mine Subsidence Homeowners and Dwelling Supplement |
70 |
Personal Policy Change Request (Except Auto) |
71 |
Personal Auto Policy Change Request |
75-N |
Insurance Binder |
75-S |
Insurance Binder |
76 |
Binder Log |
78 |
Jewelry Insurance Appraisal-Single Item |
79 |
Jewelry Insurance Appraisal |
80 |
Homeowner Application |
81 |
Personal Inland Marine Application |
82 |
Watercraft Application |
83 |
Personal Umbrella Application |
84 |
Dwelling Fire Application |
85 |
Mobile Home Application |
86 |
Personal Lines Package Application |
87 |
Personal Lines Package Application Watercraft/Inland Marine Supplement |
91 |
Good Student/Driver Training |
92 |
Medical Statement |
93 |
Young Driver Questionnaire |
125 |
Commercial Insurance Application – Applicant Information Section |
126-N |
General Liability Section |
126-S |
Commercial General Liability Section |
127 |
Business Auto Section |
128 |
Garage and Dealers Section |
129 |
Vehicle Schedule |
130 |
Workers Compensation Application |
131 |
Umbrella Section |
132 |
Truckers/Motor Carriers Section |
133 |
Workers Compensation Insurance Plan Assigned Risk Section |
139 |
Statement/Schedule of Values |
140 |
Property Section |
141 |
Crime Section |
143 |
Transportation Section |
144 |
Glass and Sign Supplement |
145 |
Accounts Receivable/Valuable Papers |
146 |
Equipment Floater Section |
147 |
Installation/Builders Risk Section |
148 |
Electronic Data Processing Section |
149 |
Dealer Section |
151 |
Miscellaneous Crime Coverage Section |
154 |
Jewelers Inventory Record |
155 |
Boiler & Machinery Section |
160 |
Business Owners Application |
161 |
Business Owners Supplemental App |
163 |
Commercial Auto Driver Information Schedule |
165 |
Small Commercial Account Package App |
175 |
Commercial Policy Change Request |
180 |
Errors and Omissions Section |
185 |
Restaurant/Tavern Supplement |
186 |
Contractors Supplement |
187 |
Professional Liability Supplement |
190 |
Supplemental Property Application |
194 |
Truckers/Motor Carrier Supplement, Request for State/Federal Filing Action |
195 |
Design Professional¹s Individual Property Survey |
200 |
Producer Account |
201 |
Producer Account Discrepancy Notice |
225 |
Policyholder¹s Report |
226 |
Statement of Premium Adjustment |
301 |
Flood Insurance Application |
302 |
Flood Insurance General Change Endorsement |
303 |
Flood Insurance Preferred Risk Policy Application |
304 |
Flood Insurance Cancellation/Nullification Form |
401 |
Agriculture Application |
402 |
Agriculture Property Section |
403 |
Agriculture Property Section |
404 |
Agriculture Liability Section |
610 |
Premium Payment Supplement |