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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name, address, and phone number as the Plaintiff at the top of the form.
  3. In the section for insurance coverage, list all known insurance policies. Start with 'Name of Insured' followed by 'Insurance Co. Name', 'Address', 'Phone', and 'Policy Number'.
  4. For each policy, circle the type of insurance: Life, Health, Auto, Home, or Other. If applicable, include details about who else is covered under each policy.
  5. If there have been any cancellations or modifications to these policies in the last ninety days, specify them in the designated area.
  6. Finally, sign and date the affidavit at the bottom and ensure it is notarized.

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