Get your claim form here!
Download and print the form you need and mail it or fax it back to:
High Point Auto Insurance
PO Box 903
Lincroft NJ, 07738
Fax: 732-978-7199
(These are Adobe PDF files, and can be read using Adobe Reader. If you do not have Adobe Reader installed, you may download it free of charge.)
| Automobile Claim Forms | ||
|---|---|---|
| Accident Diagram Provide us with a diagram of the accident |
 (143KB) |
Download |
| Affidavit of No Insurance Provide us with an affidavit that you have no insurance |
(279KB) |
Download |
| Affidavit of Vehicle Theft Provide us with affidavit on the theft of your vehicle |
(532KB) |
Download |
| Attending Physician's Treatment Plan Requests, Initial and Additional Submissions Submit your treatment plan (AICRA NJ Medical Providers Only) Standardized Department of Banking and Insurance Form, effective 10/27/2004 |
(494KB) |
Download |
| Authorization for Credit Check Provide us with authorization to obtain a credit report |
(192KB) |
Download |
| Authorization for Employment Records Provide us with authorization to obtain and view your employment records |
(205KB) |
Download |
| Authorization for Health-Related Information Provide us with authorization to obtain health related information in accordance with HIPAA requirements |
(220KB) |
Download |
| Authorization to Obtain Motor Vehicle Records Provide us with authorization to secure major vehicle records |
(198KB) |
Download |
| Decision Point Review and Pre-Certification Requirements Under Your High Point Automobile Policy Read about important information regarding the submission/reimbursement of a Personal Injury Protection (PIP) claim. This document explains rights and obligations after a covered loss |
(41KB) |
Download |
| Installment Agreement Provide us with a payment installment agreement |
(194KB) |
Download |
| Notice of Loss Form Provide us with your version of the accident |
(233KB) |
Download |
| Notification of Commencement of Treatment Notify us treatment has begun (AICRA NJ Medical Providers Only) |
(100KB) |
Download |
| PIP Application Provide us with an application of Personal Injury Protection Benefits |
(343KB) |
Download |
| Power of Attorney, Bill of Sale & Odometer Statement Provide us with power of attorney, your bill of sale and an odometer statement |
(209KB) |
Download |
| Proof of Loss, Certificate of Satisfaction, Direction of Payment and Subrogation Agreement Provide us with proof of the theft loss you sustained, a certificate of satisfaction, direction of payment and subrogation agreement |
(211KB) |
Download |
| Release - All Claims Provide us with a release of all claims |
(143KB) |
Download |
| Release - Parent Guardian Release Provide us with a release of all claims involving a minor |
(91KB) |
Download |
| Release - Release & Trust Agreement Provide us with a release and trust agreement of all claims |
(105KB) |
Download |
| Subrogation Notice of Loss Provide us with your version of the loss for the purposes of subrogation |
(184KB) |
Download |
| Wage and Salary Verification Provide us with your wage and salary information |
(314KB) |
Download |
| Witness Statement Provide us with your version of the accident as a witness |
(390KB) |
Download |
| Homeowner Claim Forms | ||
| Affidavit of Boat Theft Provide us with an affidavit on the theft of your boat |
(280KB) |
Download |
| Affidavit and-or Electrician's Report Provide us with an affidavit describing the cause of the loss |
(183KB) |
Download |
| Authorization for Employment Records Provide us with authorization to obtain and view your employment records |
(205KB) |
Download |
| Installment Agreement Provide us with a payment installment agreement |
(194KB) |
Download |
| Homeowner Statement in Proof of Loss Provide us with statement describing the loss |
(378KB) |
Download |
| Personal Property Loss Worksheet Provide us with a description of the personal property for your claim |
(171KB) |
Download |
| Proof of Loss Statement Provide us with an affidavit explaining the loss and describing the claimed property |
(314KB) |
Download |
| Release - All Claims Provide us with a release of all claims |
(143KB) |
Download |
| Release - Parent Guardian Release Provide us with a release of all claims involving a minor |
(91KB) |
Download |
| Subrogation Notice of Loss Provide us with your version of the loss for the purposes of subrogation |
(184KB) |
Download |
| Vendor Affidavit Submit your store/merchant affidavit verifying a receipt |
(253KB) |
Download |