Key takeaways
Fill, sign, and submit Sworn Statement in Proof of Loss from any browser — or have AI generate a custom version in seconds. No installs, no printing, no back-and-forth.
- The Insurance Claim Sworn Statement is used by insured individuals to initiate the claims process after property damage or loss.
- This document requires specific details about when the loss occurred and the exact origin and cause of the damage.
- Claimants must provide information regarding their legal interest in the property and the property's occupancy at the time of loss.
- The insured individual must sign the document to certify that the information provided is true and accurate.
- A notary public is required to witness the signing and notarize the document for it to be accepted.
- The form contains a warning that providing false information on a sworn statement can lead to legal consequences.
What is Sworn Statement in Proof of Loss?
Insurance Claim Sworn Statement is a document used by insured individuals to provide a formal account of loss or damage to their insured property. This statement is primarily used to initiate the claims process with an insurance company. The form requires the individual to document specific details regarding the incident, including the exact time, origin, and cause of the loss. By providing this information, the insured party establishes a record of the event for the provider to review.
The document also captures important information regarding the occupancy and interest in the property at the time of the loss. Because it is a sworn statement, the form must be signed by the insured party in the presence of a notary public. It contains a specific warning about the legal consequences associated with providing false information. Completing this form ensures that all relevant facts about the property damage are formally presented to the insurance company for assessment.
This document does not have a designated issuing authority.
Who needs the Sworn Statement in Proof of Loss — and who doesn't
Not everyone files Sworn Statement in Proof of Loss. The checklist below tells you whether it applies to your situation — and points you to the right alternative if it doesn't.
You need this Sworn Statement in Proof of Loss if…
- you are an insured individual who has experienced a loss or damage to your property.
- you must provide a detailed account of the time, origin, and cause of a loss to your insurance provider.
- you are required to certify the occupancy and your interest in the insured property through a formal document.
- your insurance company requires a signed and notarized statement to initiate the claims process.
You do not need this Sworn Statement in Proof of Loss if…
- you have not experienced any property damage or loss that requires you to file a claim.
- you are not the insured party or policyholder for the property in question.
Why you need the Sworn Statement in Proof of Loss
Why people fill out Sworn Statement in Proof of Loss, and what tends to go wrong when they don't.
-
Initiate Claims Process Use this statement to officially notify your provider of a loss. Providing clear details on the cause and origin of damage helps the insurance company begin their formal evaluation process.
-
Document Property Interest This form captures essential information regarding your occupancy and interest in the insured property. These details clarify your relationship to the assets and help establish the context of the claim.
-
Sworn Verification Completing this document requires a signature and formal notarization. This process ensures that your account of the loss is recorded as a sworn statement, providing a verified record for the insurer.
-
Secure Digital Management You can fill, edit, and sign this form using pdfFiller’s online platform. Completed documents are kept in secure, encrypted storage, making it easy to manage and share your records with agents.
What each section of Sworn Statement in Proof of Loss means
Every section explained — what it's asking, the records you'll need on hand, and the mistakes that most often cause a rejection or follow-up request.
| Loss and Damage Details | Enter specific information regarding when the loss occurred, the origin of the incident, and the primary cause of the damage to the insured property. |
|---|---|
| Property Occupancy and Interest | Provide a description of who was occupying the property at the time of the loss and detail your legal interest in the insured asset. |
| Notary Public Acknowledgment | This area is reserved for the Notary Public to sign and seal the document after witnessing the insured individual's signature on the sworn statement. |
How to fill out Sworn Statement in Proof of Loss using pdfFiller
A walkthrough from the first field to the signature line. With your records in front of you, most people finish in under ten minutes.
-
Open the Form Click Get Form to open Insurance Claim Sworn Statement in the pdfFiller editor to start filling out your document in a secure, web-based environment without needing extra software.
-
Detail the Loss Input the necessary information into the Loss Details section by typing the specific date, time, origin, and cause of the damage directly into the provided insurance claim form fields.
-
Describe Property Interest Complete the Property Interest area of the sworn statement template by describing the occupancy of the premises and your specific interest in the property at the time of loss.
-
Sign as Insured Apply a legally binding e-signature to the Insured signature line using the sign tool, ensuring you have reviewed all entries for accuracy before the final submission process.
-
Prepare Notary Section Leave the Notary Section ready for the official's signature, utilizing pdfFiller's editing tools to ensure the document is properly prepared for the mandatory notarization required for this claim.
-
Secure and Share Store your document in pdfFiller's secure encrypted storage which is SOC 2 and PCI DSS compliant, then share the finished PDF with your insurance provider via email or link.
Related content
The forms, guides, and worksheets most filers reach for alongside Sworn Statement in Proof of Loss.
Key terms used in Sworn Statement in Proof of Loss
A one-sentence glossary of the Sworn Statement in Proof of Loss terms and concepts you'll see throughout this guide.
- Insured
- The individual covered by the insurance policy who is filing the claim for property damage.
- Loss Details
- A description of the specific circumstances, including the time, cause, and origin of the reported damage.
- Property Interest
- The insured's legal or financial relationship to the property, including their occupancy and ownership status.
- Sworn Statement
- A written declaration of facts regarding a claim that must be signed and notarized by the insured.
- Origin of Loss
- The specific starting point or source from which the damage to the property began.
Frequently asked questions about Sworn Statement in Proof of Loss
Quick answers to the questions we hear most often about completing the Sworn Statement in Proof of Loss.
An Insurance Claim Sworn Statement is a document used by insured individuals to provide a detailed account of loss or damage to their property to initiate a claims process. This form requires the claimant to provide specific details regarding the time, origin, and cause of the incident. It serves as a formal record for the insurance provider to evaluate the claim.
Insured individuals who are filing a claim for property loss or damage must sign this document in the presence of a notary. The form acts as a formal declaration by the policyholder to their insurance provider regarding the details of the incident. By signing the statement, the insured verifies that all information provided about the loss is true and accurate.
The Loss Details section requires the insured to describe the specific time, origin, and cause of the loss or damage. Providing accurate and thorough information in this part is essential for the insurance company to understand the circumstances of the event. This section helps establish the facts surrounding the incident and determines if the loss falls under the policy's coverage.
Yes, the Insurance Claim Sworn Statement includes a warning regarding the legal consequences of providing false information. This notice ensures that all claimants understand the importance of honesty when detailing their property loss. Because this document is signed under oath and notarized, the warning serves to remind the insured that providing inaccurate data can result in serious legal outcomes.
The Property Interest section is used to describe the occupancy of the insured property and the specific interest the claimant has in it. This helps the insurance company verify who owns or occupies the property and what rights they have under the insurance policy. Clearly defining these interests prevents confusion during the claim settlement and ensures the correct parties are compensated.
The Insurance Claim Sworn Statement must be signed by the insured and notarized by a qualified notary public. This requirement ensures the authenticity of the signature and that the details of the loss are provided under oath. The notary section is a mandatory part of the document, and the signature must be witnessed by the notary to fulfill the form's specific procedural requirements.
You can fill out, sign, and manage the Insurance Claim Sworn Statement using pdfFiller’s comprehensive online editing tools. The platform allows you to add a legally binding e-signature and even provides access to online notarization services to complete the notary section. Once finished, you can share the PDF with your insurance agent via link or email, or save it in secure encrypted storage.
