UCJF Forms


Form Description
Notice of Intention to Make Claim

Written notice to the Association that a claim may be made as required under N.J.S.A. 39:6-65. Separate notice must be filed on behalf of each claimant.

PIP Application

Form made in support of a claim. Must be fully completed and submitted to the Association.

Affidavit of No Insurance

Sworn statement made in support of a claim. Must be fully completed, notarized and submitted to the Association.

Certificate of Medicare Eligibility

Sworn statement made in support of a claim. Must be fully completed and submitted to the Association.

HIPAA Privacy Authorization

Authorization for use or disclosure of protected health information pursuant to the Health Insurance Portability and Accountability Act.