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Sworn Statement in Proof of Loss free printable template
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POLICY NUMBER Sworn Statement POLICY AMT. AT TIME OF LOSS DATE ISSUED DATE EXPIRES IN PROOF OF LOSS COMPANY CLAIM NUMBER AGENT AGENCY AT To the INSURANCE COMPANY NAME of CITY STATE At time of loss by the above indicated policy of insurance you insured against loss by to the property described according to the terms and conditions of said policy and of all forms endorsements transfers and assignments attached thereto. Any other information that may be required will be furnished and considered a...part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of its rights. State Of Insured County Of Subscribed and sworn to before me this day of Personally Known to Me I. D. STATEMENTS OF INSURED The said loss did not originate by any act design or procurement on the part of your insured or this affiant nothing has done by or with the privity or consent of your insured or this affiant to violate the...conditions of the policy or render it void no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss no property saved has in any manner been concealed and no attempt to deceive the said company as to the extent of said loss has in any manner been made. Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the...above insurance company is not a waiver of any of its rights. TIME AND ORIGIN The cause and origin of the said loss were OCCUPANCY The building described or containing the property described was occupied at the time of the loss as follows and for no other purpose whatever. At the time of the loss the interest of your insured in the property described therein was INTEREST encumbrance thereon except Since the said policy was issued there has been no assignment thereof or change of interest use...occupancy possession location or exposure of the property described except TITLE AND CHANGES TOTAL THE TOTAL AMOUNT OF INSURANCE upon the property described by this policy was at the time of the loss policy or other contract of insurance written or oral valid or invalid* VALUE THE ACTUAL CASH VALUE of said property at the time of the loss was. LOSS THE WHOLE LOSS AND DAMAGE was. AMT. CLAIMED THE AMOUNT CLAIMED under the above numbered policy number is. STATEMENTS OF INSURED The said loss did not...originate by any act design or procurement on the part of your insured or this affiant nothing has done by or with the privity or consent of your insured or this affiant to violate the conditions of the policy or render it void no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss no property saved has in any manner been concealed and no attempt to deceive the said company as to the extent of said loss has in any manner been made....Any other information that may be required will be furnished and considered a part of this proof* The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of its rights.
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Understanding the Sworn Statement in Proof Form
Definition of the sworn statement in proof form
A sworn statement in proof form is a formal document used in the context of insurance claims. It serves as a declaration by the policyholder regarding the details of a loss or damage incurred. This statement is crafted to convey the facts related to the incident, affirming its authenticity through the policyholder’s signature and oath.
Key components of the sworn statement
The sworn statement includes several essential components that must be addressed for it to be valid. These components consist of the policy number, details of the loss, the value of the damaged property, and a declaration that the loss did not result from the policyholder's misconduct. This transparency helps ensure that the claims process is straightforward and based on accurate information.
Filling out the sworn statement accurately
To complete the sworn statement, it is crucial to provide accurate and detailed information. Begin by entering the policyholder's information, followed by the specifics of the loss, including date, time, and cause. Clearly state the value of the property at the time of loss and ensure that you disclose any other individuals with an interest in the property. Review the form for completeness and clarity before signing it.
When to utilize the sworn statement in proof form
Typically, the sworn statement is employed when a policyholder reports a loss that requires validation for an insurance claim. This includes instances of property damage due to various causes. It is essential to submit this document promptly after the loss occurs to facilitate a timely claims process. Engaging with the sworn statement ensures that the insurance company has the necessary information to assess and process the claim effectively.
Common pitfalls to avoid
When filing a sworn statement, it is important to avoid common errors that can delay the claims process. Ensure that all fields are filled out completely and accurately. Double-check the facts regarding the loss, including dates and descriptions. Avoid omitting any details that could be significant to the claim. Neglecting these aspects can lead to complications or even rejection of the claim, so thoroughness is essential.
Validation and review considerations
Before submitting the sworn statement, it is advisable to review the document for consistency and completeness. Consider having a trusted advisor or legal representative review it if there are any uncertainties. Ensuring that the information is accurate and comprehensive can help prevent delays in claim processing and affirm the legitimacy of the statement provided.
Frequently Asked Questions about property statement proof of loss form
What is the purpose of a sworn statement in proof form?
The purpose of a sworn statement in proof form is to provide a formal written declaration to an insurance company, detailing a loss or damage that has occurred, thereby facilitating the claims process.
Who is responsible for completing the sworn statement?
The policyholder is responsible for completing the sworn statement, providing accurate information regarding the loss, and signing the document to affirm its authenticity.
How does one ensure the sworn statement meets legal requirements?
To ensure the sworn statement meets legal requirements, it is important to adhere to any specific local regulations and to provide complete, honest, and concise information about the loss, verifying facts and including necessary signatures.
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People Also Ask about statement of loss and profit
How do I fill out a proof of loss form?
How to fill out a Proof of Loss form Coverage amounts at the time of the loss; Date and cause of the loss; A complete list of all damaged, destroyed or stolen items. Documents that support the value of the property and the amount of loss claimed (i.e. estimates, inventories, receipts, etc.)
How do I fill out a proof of loss form?
How to fill out a Proof of Loss form Coverage amounts at the time of the loss; Date and cause of the loss; A complete list of all damaged, destroyed or stolen items. Documents that support the value of the property and the amount of loss claimed (i.e. estimates, inventories, receipts, etc.)
Whose responsibility is it to complete a proof of loss?
This is known as a Proof of Loss form for most carriers. It is your job as the claimant on the policy to complete this as quickly and as accurately as possible.
What is the purpose of a proof of loss form?
Proof of loss is a legal document that explains what's been damaged or stolen and how much money you're claiming. Your insurer may have you fill one out, depending on the loss. Homeowners, condo and renters insurance can typically help cover personal property.
What is a cause of loss statement form?
A causes of loss form is combined with one or more coverage forms, the commercial property conditions form, the common policy conditions form, and the declarations to make up an ISO commercial property policy. There are three causes of loss forms: the basic, broad, and special causes of loss forms.
What is a proof of loss statement form?
The Proof of Loss form is an official, notarized, sworn statement from the insured to the insurer concerning the scope of damage to their property. The insurance company uses this information as a basis for determining their liabilities for the property loss.
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