Automobile/Inland Marine Fund
The following forms should be used to notify NCSBT of automobile accidents or losses, inland marine losses, or vehicle schedule changes.
Automobile Loss Notice Form: This form must be completed and submitted to NCSBT promptly following an automobile accident or loss, along with a written statement from the driver of the member vehicle describing the accident or loss and a copy of the police report and any complaint, petition or other pleading filed in court as a result of the accident or loss.
Vehicle Change Request Form: This form must be completed to make an addition, deletion, or change to your vehicle schedule.
Inland Marine Loss Notice Form: This form must be completed and submitted to NCSBT promptly, or in any event within fifteen (15) days of discovery of the loss. Please also attach a copy of any incident report prepared, and a copy of the receipt, purchase order, or invoice for the covered property.
Inland Marine Change Request Form: This form must be completed to make additions or deletions to your scheduled inland marine equipment as set forth on the form.
Errors & Omissions/General Liability Fund—Drone Liability Coverage
The following form should be used to create or modify a member’s drone schedule on file with NCSBT.
Drone Liability Schedule Change Request
Errors & Omissions/General Liability Fund—First-Party Cyber Endorsement
The following forms should be submitted to NCSBT after a member experiences a Cyber Incident.
Notice of Cyber Incident: This form must be completed within fifteen (15) days of the member’s discovery of an Electronic Data Loss, a Data Breach, or a Cyber Extortion.
Cyber Reimbursement Request: This form should be submitted to NCSBT after a member has paid its final invoice to the Consultant(s) responding to the member’s Cyber Incident.
Errors & Omissions/General Liability Fund—Medical Payments Coverage
The following forms should be used when filing a claim or submitting information related to a claim under NCSBT’s no-fault medical expense coverage.
Medical Expense Certificate: The Medical Expense Certificate, along with all requested documentation, must be completed and submitted within one year of an accidental injury.
Supplement to Medical Expense Certificate: The Supplement to the Medical Expense Certificate, along with all requested documentation, may be completed and submitted within fourteen (14) months of an accidental injury. It should only be used to supplement a previously completed Medical Expense Certificate that was submitted within within one year of an accidental injury.