CertiMotive© Hail Scope Sheet
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
CertiMotive© ID#
*
ID# must be Input to use this Form
Appraisers First Name
*
Appraisers Last Name
*
Appraisers Email
*
example@example.com
Claim #
*
IA Co File #
Ins Co
*
Please Select
Self-Insured
AAA
AARP
21st Century Insurance
ACE Limited
Acuity
Aetna
Affirmative Insurance
Aflac
Alleghany Corporation
Allied Insurance
Allstate
American Automobile Association
American Family Insurance
American Income Life Insurance Company
American International Group (AIG)
American National Insurance Company
Ameriprise
Ameritas Life Insurance Company
Amica Mutual Insurance
Applied Underwriters
Arbella Insurance Group
Assurant
Assurity Life Insurance Company
Auto Club
Auto-Owners Insurance
AXA Equitable Life Insurance Company
Bankers Life and Casualty Company
Berkshire Hathaway
Chubb Corp.
Cincinnati Insurance Company
CNA Financial
Colonial Life & Accident Insurance Company
Combined Insurance
Commerce Insurance Group
Conseco
Country Financial
Elephant.com
Encompass Insurance Company
Erie Insurance Group
Esurance
Evergreen USA RRG
Farmers Insurance Group
Federated Mutual Insurance Company
First Insurance Company of Hawaii
FM Global
GAINSCO
GEICO
General Re
Genworth Financial
Gerber Life Insurance Company
GMAC Insurance
Gracy Title Company
Grange Mutual Casualty Company
Guardian Life Insurance Company of America
GuideOne Mutual Insurance
Hanover Insurance
The Hartford
HCC Insurance Holdings
Hiscox Small Business Insurance
Horace Mann
Infinity Property & Casualty Corporation
IntelliQuote Insurance Services
Ironshore
Jackson National Life
John Hancock Insurance
K&K Insurance
Kansas City Life Insurance Company
Kentucky Farm Bureau
Knights of Columbus
Liberty Mutual
Lincoln National Corporation
Manhattan Life Insurance Company
Markel Corporation
MassMutual
Merchants Insurance Group
Mercury Insurance Group
MetLife
Modern Woodmen of America
Mutual of Omaha
National Life
Nationwide Mutual Insurance Company
New Jersey Manufacturers Insurance Company
New York Life Insurance Company
The Norfolk & Dedham Group
Northwestern Mutual
Omega
OneBeacon
Oxford Health Plans
Pacific Life
Pacificare
PEMCO
Penn Mutual
Philadelphia Contributionship for the Insurance of Houses from Loss by Fire
Philadelphia Insurance Companies
Physicians Mutual
Primerica
Principal Financial Group
Progressive
Protective Life
Prudential Financial
QBE
The Regence Group
Reliance Insurance Company
RLI Corp.
Safe Auto Insurance Company
Safeco
Safeway Insurance Group
Selective Insurance
Sentry Insurance
Shelter Insurance
Southern Aid and Insurance Company
Standard Insurance Company
State Farm Insurance
Sun Life Financial
Symetra
TIAA-CREF
Transamerica Corporation
The Travelers Companies
Trupanion
Unum
USAA
West Bend[disambiguation needed]
West Coast Life
Western & Southern Financial Group
Western Mutual Insurance Group
Westfield Insurance
Westminster American Insurance Company
White Mountains Insurance Group
Other Insurance
If Other, List Here
Vehicle Year
*
Please Select
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
Vehicle Make
*
Please Select
Acura
Alfa Romeo
AM General
American Motors
Aston Martin
Audi
Austin/Austin Healey
Avanti
Auto-Union-DKW
Bentley
Bertone
Bluebird
BMW
Bricklin
Brockway
BSA
Buick
Cadillac
Carpenter
Checker
Chevrolet
Chrysler
Citroen
Collins Bus
Daewoo
Daihatsu
Datsun
DeLorean
Desoto
Desta
Diamond Reo or Reo
DINA
Divco
Dodge
Ducati
Eagle
Eagle Coach
Excaliber
Ferrari
Fiat
Ford
Freightliner
FWD
Gazelle
Gillig
GMC
Grumman
HarleyDavidson
Hillman
Hino
Honda
Hudson
Hyundai
Imperial
Infiniti
International Harvester
Isuzu
Iveco/Magirus
Jaguar
Jensen
Jeep
Kaiser-Jeep
Kawasaki
Kenworth
Kia
Koenigsegg
Lada
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Mack
Mahinda
Maserati
Maybach
Mazda
MCI
Mercedes-Benz
Mercury
Merkur
Mid Bus
Mini-Cooper
MG
Mitsubishi
Morgan
Morris
Moto-Guzzi
Navistar
Neoplan
Nissan
Norton
Oldsmobile
Opel
Orion
Oshkosh
Packard
Panoz
Peterbilt
Peugeot
Plymouth
Pontiac
Porsche
Reliant
Renault
Rolls Royce
Saab
Saleen
Saturn
Scania
Scion
Simca
Singer
Smart
Spyker
Sterling
Sterling
Studabaker
Stutz
Subaru
Sunbeam
Suzuki
Tesla
Thomas Built
Toyota
Triumph
TVR
UD
Van Hool
Victory
Volkswagen
Volvo
Western Star
White/Autocar
White/GMC
Willys-Jeep
Yamaha
Yes
Yugo
Vehicle Model
*
If Pre-1995, list Year here
Mileage (Odometer - NOT KM)
*
Hail Matrix - Type in Size and Amount
Rows
1-5 Dents D N Q H CR
6-15 Dents D N Q H CR
16-30 Dents D N Q H CR
31-50 Dents D N Q H CR
51-75 Dents D N Q H CR
Hood
Roof
Decklid/Liftgate
L Fender
L FT DR
L RR DR
L Qtr
L Rail/Uniside
R Fender
R FT DR
R RR DR
R Qtr
R Rail/Uniside
Large Amounts - Type in Size and Amount
Rows
76-100 Dents D N Q H CR
101-150 Dents D N Q H CR
151-200 Dents D N Q H CR
201-300 Dents D N Q H CR
Hood
Roof
Decklid/Liftgate
Oversize - Type in Amount
Rows
OS - Amount
Hood
Roof
Decklid/Liftgate
L Fender
L FT DR
L RR DR
L Qtr
L Rail/Uniside
R Fender
R FT DR
R RR DR
R Qtr
R Rail/Uniside
Add Ons - Add 25%
Rows
Alum
HSS
Glue Pull
Other - Note below
Hood
Roof
Decklid/Liftgate
L Fender
L FT DR
L RR DR
L Qtr
L Rail/Uniside
R Fender
R FT DR
R RR DR
R Qtr
R Rail/Uniside
Other Note for Add Ons
R&I (AIAG Codes List)
Antenna/Antenna Base
Battery/Box
Bumper/Cover/Ext-Front
Bumper/Cover/Ext-Rear
Bumper Guard/Strip-Front
Bumper Guard/Strip-Rear
Door-Back Cargo, Right
Door-Back Cargo, Left
Door-Right Cargo
Door-Left Front
Door-Left Front Emblems/Mldgs
Door-Left Rear
Door-Left Rear Mldgs
Door-Right Front
Door-Right Front Emblems/Mldgs
Door-Right Rear
Door-Right Rear Mldgs
Fender-Left Front
Fender-Left Front Emblems/Mldgs/Flare
Quarter Panel/Pick-Up Box Left
Quarter Panel/Pick-Up Box Left Emblems/Mldgs/Flare
Fender-Right Front
Fender-Right Front Emblems/Mldgs/Flare
Quarter Panel/Pick-Up Box - Right
Quarter Panel/Pick-Up Box - Right Emblems/Mldgs/Flare
Front Floor Mats
Floor Mats Rear
Glass Windshield
Glass Rear
Grille
Accessory Bag/Box
Headlight/Cover/Turn Signal
Lamps-Fog/Driving/Spot Light
Headliner
Hood
Hood Insulator
Hood Seal
Keys
Keyless Remote
Mirror-Outside Left
Mirror-Outside Right
Audio/Video Player
TV/DVD Screen
Rocker Panel/Outer Sill - Left
Rocker Panel/Outer Sill - Right
Roof
Running Board/Step - Left
Running Board/Step - Right
Spare Tire/Wheel
Splash Panel/Spoiler - Front
Gas Tank
Tail Light/Hardware
Trim Panel-Front Left
CD Changer Separate Unit
Trim Panel-Front Right
Deck Lid/Tailgate/Hatchback
Sunroof/T-Top
Undercarriage-Other
Cargo Area-Other
Vinyl/Convertible Top/Tonneau Cover
Wheel Covers/Caps/Rings
Radio Speakers
Wipers, all
Box Interior, Pickup
Rails, Truckbed/Lightbar
Spoiler/Deflector-Rear
Luggage Rack (Strips Drip Rail)
Dash/Instrument Panel
Cigarette Lighter/Ashtray
Carpet-Front
Center Post, Right
Center Post Left
Corner Post
Left Front Tire
Left Front Wheel/Rim
Left Rear Tire
Left Rear Wheel/Rim
Right Rear Tire
Right Rear Wheel/Rim
Right Front Tire
Right Front Wheel/Rim
Cowl
Gas/Cap Cover
Fender-Rear Left
Fender-Rear Right
Tools/Jacks/Spare-Tire Mount + Lock
Communication/GPS Unit
Parking Sonar System
Trailer Hitch, Wiring Harness, Tow Hooks
Frame
Exhaust System
License-Bracket
Steering Wheel/Airbag
Seat-Front Left
Seat-Front Right
Seat-Rear
Carpet-Rear
Interior-Other
Engine Compartment-Other
Other
R&I Notes & "Other":
Replace (AIAG Code List)
Antenna/Antenna Base
Battery/Box
Bumper/Cover/Ext-Front
Bumper/Cover/Ext-Rear
Bumper Guard/Strip-Front
Bumper Guard/Strip-Rear
Door-Back Cargo, Right
Door-Back Cargo, Left
Door-Right Cargo
Door-Left Front
Door-Left Front Emblems/Mldgs
Door-Left Rear
Door-Left Rear Mldgs
Door-Right Front
Door-Right Front Emblems/Mldgs
Door-Right Rear
Door-Right Rear Mldgs
Fender-Left Front
Fender-Left Front Emblems/Mldgs/Flare
Quarter Panel/Pick-Up Box Left
Quarter Panel/Pick-Up Box Left Emblems/Mldgs/Flare
Fender-Right Front
Fender-Right Front Emblems/Mldgs/Flare
Quarter Panel/Pick-Up Box - Right
Quarter Panel/Pick-Up Box - Right Emblems/Mldgs/Flare
Front Floor Mats
Floor Mats Rear
Glass Windshield
Glass Rear
Grille
Accessory Bag/Box
Headlight/Cover/Turn Signal
Lamps-Fog/Driving/Spot Light
Headliner
Hood
Hood Insulator
Hood Seal
Keys
Keyless Remote
Mirror-Outside Left
Mirror-Outside Right
Audio/Video Player
TV/DVD Screen
Rocker Panel/Outer Sill - Left
Rocker Panel/Outer Sill - Right
Roof
Running Board/Step - Left
Running Board/Step - Right
Spare Tire/Wheel
Splash Panel/Spoiler - Front
Gas Tank
Tail Light/Hardware
Trim Panel-Front Left
CD Changer Separate Unit
Trim Panel-Front Right
Deck Lid/Tailgate/Hatchback
Sunroof/T-Top
Undercarriage-Other
Cargo Area-Other
Vinyl/Convertible Top/Tonneau Cover
Wheel Covers/Caps/Rings
Radio Speakers
Wipers, all
Box Interior, Pickup
Rails, Truckbed/Lightbar
Spoiler/Deflector-Rear
Luggage Rack (Strips Drip Rail)
Dash/Instrument Panel
Cigarette Lighter/Ashtray
Carpet-Front
Center Post, Right
Center Post Left
Corner Post
Left Front Tire
Left Front Wheel/Rim
Left Rear Tire
Left Rear Wheel/Rim
Right Rear Tire
Right Rear Wheel/Rim
Right Front Tire
Right Front Wheel/Rim
Cowl
Gas/Cap Cover
Fender-Rear Left
Fender-Rear Right
Tools/Jacks/Spare-Tire Mount + Lock
Communication/GPS Unit
Parking Sonar System
Trailer Hitch, Wiring Harness, Tow Hooks
Frame
Exhaust System
License-Bracket
Steering Wheel/Airbag
Seat-Front Left
Seat-Front Right
Seat-Rear
Carpet-Rear
Interior-Other
Engine Compartment-Other
Other
Replace Notes & "Other":
Add'l Notes:
Submit
Should be Empty: