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Sworn statement in proof of loss template

Sworn statement in proof of loss 2026

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The document is a Sworn Statement in Proof of Loss for an automobile insurance claim. It outlines the details of the insured vehicle, the circumstances of the loss, and the insured's claims regarding ownership, value, and conditions of the policy. The statement includes sections on warranties, purchase information, total insurance coverage, amount claimed, assignment of interest to the insurer upon payment, subrogation rights, and affirmations by the insured regarding the use and condition of the vehicle at the time of loss.

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Click ‘Get Form’ to open the sworn statement in proof of loss in the editor.
Begin by entering the amount of your policy at the time of loss, along with your policy number and claim number.
Fill in the issue date and expiration date, as well as your agent's name for reference.
Provide details about the insured vehicle, including model year, make, body type, vehicle ID number, motor ID, and license plate number.
Describe the origin of the loss by specifying what caused it and when it occurred. Include full particulars for clarity.
Complete sections regarding warranties, purchase details, ownership status, and value of the automobile at the time of loss.
State the total insurance covering the incident and specify the amount you are claiming from the company.
Sign and date the document before a notary public to finalize your sworn statement.

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