Carolina Casualty Insurance Corporation
Applications
State Applications for 15 and under Power Units
Effective
2-2008
Non-Fleet Application 1-15 Units
(Please include appropriate State Supplemental)
Non-Fleet Application Extension
IL Supplemental Application 1-15 Units
IN Supplemental Application 1-15 Units
KY Supplemental Application 1-15 Units
MI Supplemental Application 1-15 Units
OH Supplemental Application 1-15 Units
   
Fleet Application (CTP5036 04-08)
Fleet Application Word Fill (CTP5036 04-08)
Non Trucking Application (CTP5446 02-00)
Non Trucking Application Word Fill (CTP5446 02-00)
Cargo Application (CTP5377 02-00)
Cargo Application Word Fill (CTP5377 02-00)
G/L Liability Supplemental (CTP5038 07-99)
G/L Liability Supplemental Word Fill (CTP5038 07-99)
Racing Program (CTP5525 02-00)
Hired Non Owned Supplemental (CTP5599 07-99)
Hired Non Owned Supplemental Word Fill (CTP5599 07-99)
Truckers Supplement to Acord (CTP 5599 07-99)
Truckers Supplement to Acord Word Fill
(CTP 5599 07-99)
Uninsured & Underinsured Motorist, PIP Forms
UM/UIM Selection Form - Arizona (CTP5353 10-03)
UM/UIM Selection Form - Arizona Word Fill (CTP5353 10-03)
UM/UIM Selection Form - Arkansas (CTP5442 10-99)
UM/UIM Selection Form - Colorado (CTP5275 12-06)
UM/UIM Selection Form - Colorado Word Fill (CTP5275 12-06)
UM/UIM Selection Form - Illinois (ILU003 09-03)
UM/UIM Selection Form - Indiana (CTP5320_10-96)
UM/UIM Selection Form - Indiana Word Fill (CTP5320_10-96)
UM Selection Rejection Form - Kansas (IL U 047 03-06)
UM/UIM Selection Form - Kentucky (CTP5321_12-93)
UM/UIM Selection Form - Kentucky Word Fill (CTP5321_12-93)
UM/UIM Selection Form - Maryland (CTP5325 01-03)
UM/UIM Selection Form - Maryland Word Fill (CTP5325 01-03)
Waiver of PIP Coverage - Maryland (CTP5324 12-93)
Waiver of PIP Coverage - Maryland Word Fill (CTP5324 12-93)
UM/UIM Selection Form - Michigan (CTP5362 03-02)
UM/UIM Selection Form - Michigan Word Fill (CTP5362 03-02)
PIP Stacking Options - Minnesota (CTP5327 12-93)
PIP Stacking Options - Minnesota - Word Fill (CTP5327 12-93)
UM/UIM Selection Form - Missouri (CTP5403 06-98)
UM/UIM Selection Form - Missouri Word Fill (CTP5403 06-98)
UM/UIM Selection Form - Nebraska (CTP5329 01-96)
UM/UIM Selection Form - Nebraska Word Fill (CTP5329 01-96)
UM/UIM Selection Form - New Jersey (CTP5528 08-98)
UM/UIM Selection Form - New Jersey Word Fill (CTP5528 08-98)
UM/UIM Selection Form - North Carolina (CTP5331 12-93)
UM/UIM Selection Form - North Carolina - Word Fill (CTP5331 12-93)
UM/UIM Selection Form - Oklahoma (IL U 023 04 05)
UM/UIM Selection Form - Oklahoma Word Fill (IL U 023 04 05)
UM/UIM Selection Form - Ohio (CTP5332 06-08)
UM/UIM Selection Form - South Carolina (ILU_007_01-07)
UM/UIM Selection Form - South Carolina Word Fill (ILU_007_01-07)
UM/UIM Selection Form - Tennessee (CTP5340 12-93)
UM/UIM Selection Form - Tennessee Word Fill (CTP5340 12-93)
UM Selection Form - Virginia (CTP5064_04-04)
UM Selection Form - Virginia Word Fill (CTP5064_04-04)
UM Selection Form - Washington (CA2134 03-06)
UM Selection Form - Washington - Word Fill (CA2134 03-06)
UNDERINSURED Selection Form - Washington (ILU008 04-06)
UNDERINSURED Selection Form - Washington -
Word Fill (ILU008 04-06)
PIP Selection Form - Washington - (CTP 5448 06-94)
PIP Selection Form - Washington - Word Fill (CTP 5448 06-04)
UM Selection Form - West Virginia (ILU011 09-03)
UM Selection Form - West Virginia Word Fill (ILU011 09-03)
Supplements and other forms
Estimated Annual Rates for Ohio UM/UIM
Physical Damage Monthly Report of Values
(509 06-98)
Physical Damage Monthly Report of Values
Word Fill (509_06-98)
Monthly Report of Gross Receipts or Mileage (583 11-07)
Monthly Report of Gross Receipts or Mileage Word Fill (583 11-07)
Letter of Credit (Sample)
Security Agreement - Deductible Liability Agreement (Sample)
Passengers and For-Hire Truckers
Loss Reporting Procedures
Driver Guidelines
Lost Policy Release (ILT001 05-05)
Supplemental Application - Municipal and County Taxes -
AL, AR, DE, FL, KY, LA, MD, NV, SC (578 09-00)
Supplemental Application - Municipal and County Taxes -
AL, AR, DE, FL, KY, LA, MD, NV, SC Word Fill (578 09-00)
Minnesota Supplemental Application (CTP5360 08-94)
Minnesota Supplemental Application Word Fill (CTP5360 08-94)
Oklahoma Sexual Abuse Exclusion Endorsement
(CTP 5408 06-92)
Oklahoma Sexual Abuse Exclusion Endorsement Word Fill
(CTP 5408 06-92)
Empire Companies /Zurich
Applications
Commercial Auto Application (EM2001)
Commercial Auto Application word fill (EM2001)
Cargo Application (EM2002)
General Liability - Truckers (EM2005)
Non Trucking (EM2022)
Ambulance Application (EM2050)
Public Auto - except Taxi (EM2016)
Uninsured & Underinsured Motorist Forms
Illinois UM/UIM Selection/Rejection Form (EM1002)
Illinois UM/UIM Selection/Rejection Form word fill (EM1002)
Indiana UM/UIM Selection/Rejection Form (EM1020)
Indiana UM/UIM Selection/Rejection Form
word fill (EM1020)
Ohio UM/UIM Selection/Rejection Form (EM1020)
Supplements and other forms
Limo Supplemental (EM2226)
Limo Supplemental Word Fill (EM2226)
Non-Emergency Med & Handicapped Supplement (EM2242)
Hired Auto Supplement (EM2214)
Hired Auto Supplement word fill (EM2214)
Non Owned Auto Supplemental (EM2213)
Non Owned Auto Supplemental word fill (EM2213)
Terrorism Rejection Form (EM1119)
Terrorism Rejection Form word fill (EM1119)
Driver Guidelines
National Casualty / Scottsdale Insurance
Applications
Commercial Auto Application (CA-APP-1)
Commercial Auto Application (CA-APP-1) word fill
Commercial Auto Application Renewal (CA-APP-REN-1)
Commercial Auto Application Renewal (CA-APP-REN-1) word fill
Motor Truck Cargo Application (CTS-APP-2)
Motor Truck Cargo Application (CTS-APP-2) word fill
Motor Truck Cargo Supplemental (CTS-APP-1)
General Liability Supplemental Application
Non-Trucking Application (CAS-APP-8) SIC
Garage Insurance Application
Truck Driving School Application
Truck Driving School Application word fill
Uninsured & Underinsured Motorist Forms
UM/UIM Selection Form Arkansas
UM/UIM Selection Form Illinois
UM/UIM Selection Form Indiana
UM/UIM Selection Form Kentucky
UM/UIM Selection Form Missouri
Estimated Annual Rates for Ohio UM/UIM
UM/UIM Selection Form Ohio
UM/UIM Selection Form Ohio word fill
UM/UIM Selection Form Oklahoma
Supplements and other forms
Kentucky No Fault / PIP (NF1a 1 P&C)
Audit Report - Commercial Auto (CA-STMT-2)
Broker of Record Letter (UTS-217)
Drive-A-Way/Toter Supplemental (CA-APP-18)
Drive-A-Way/Toter Supplemental (CA-APP-18) word fill
Hazardous Material Supplemental (CA- APP-19)
Hazardous Material Supplemental (CA- APP-19) word fill
Hired & Non-Owned Auto Supplement (CA-APP-12)
Hired & Non-Owned Auto Supplement
(CAS-APP-12) SIC
Public Auto - Ambulance (CAS-APP-3)
Public Auto - Ambulance (CAS-APP-3) word fill
Public Auto - Charter / Sightseeing / Intercity Buses
(CA-APP-2)
Public Auto – Charter / Sightseeing / Intercity Buses
(CAS-APP-2) word fill
Public Auto - Limousine and Airport Shuttle
(CA-APP-4)
Public Auto – Limousine and Airport Shuttle
(CAS-APP-4) word fill
Public Auto - Non-Emergency Transport (CA-APP-20)
Public Auto - Non-Emergency Transport (CA-APP-20)
Public Auto - All Other Risks (CA-APP-5)
Public Auto - All Other Risks (CA-APP-5) word fill
Tow Trucks / Wreckers Supplemental (CA-APP-16)
Driver Guidelines
Claim Reporting Information
Monthly Reporter for Liability
Monthly Reporter for Liability (word fill)
Monthly Reporter for Physical Damage
Monthly Reporter for Physical Damage (word fill)
American Service Insurance
Applications
Coming Soon!
Lloyds of London
Applications
Auto Physical Damage (NMA1561)
Motor Truck Cargo Proposal / Application
Ocean Marine Cargo Application
New Venture Profile
Logging Equipment Proposal / Application
Trash & Safeguard Warranty
Disclosure Notice of Terrorism
Great American Insurance Company
Applications
Cargo Application
Supplements and other forms
Freight Forwarders Liability and Contingent Cargo
Transportation Brokers Liability and Contingent Cargo
Hartford
Applications
Hartford Motor Truck Cargo Application
Hartford Motor Truck Cargo Application Word Fill
Confirmation of Rejection of Coverage – Terrorism Risk Insurance Act Inland Marine (IH 09 54 02 06)
Confirmation of Rejection of Coverage – Terrorism Risk Insurance Act Inland Marine Word Fill (IH 09 54 02 06)
   
Hartford - Carrier For Hire Marketing Information
Hartford - Cargo Coverage Analyzer
   
Cargo Coverage Form Sample Form
Cargo Extra Expense Sample Form
Mechanical Breakdown of Refrigeration Sample Form
Carrier For Hire Reporting Endorsement Sample Form
 
Hartford - Worldwide Transportation Policy Marketing Material
Ocean Cargo Application
Hartford - Ocean Cargo Coverage Analyzer
Great Lakes Reinsurance (UK) PLC
Applications
Coming Soon!
Miscellaneous Forms
Drive-A-Way & Toter Questionnaire
Drive-A-Way & Toter Questionnaire Word Fill
Truck Driving School Questionnaire
Terminal Questionnaire
AIG Trucker Occupational Hazard Questionnaire
AIG Passenger Questionnaire
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