SUNZ Insurance Company Loss History Affidavit 2026

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  1. Click ‘Get Form’ to open the SUNZ Insurance Company Loss History Affidavit in the editor.
  2. Begin by filling in the 'Company Information' section. Enter the name of the owner/officer and the legal name of the company, ensuring accuracy for validation purposes.
  3. In the 'Loss History Acknowledgement' section, select one of the two options regarding work-related injuries. If applicable, provide details about any injuries reported in the last five years, including employee names, injury dates, types of injuries, total claim costs, and insurance carrier information.
  4. If there are more claims than can fit on the form, note that additional claims should be documented on a separate sheet using the same format.
  5. Complete the signature section by having the owner/officer sign and date the affidavit. Remember that electronic signatures are prohibited.
  6. If applicable, have a PEO representative complete their acknowledgment section with their name and signature.

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2018 4.8 Satisfied (224 Votes)
2016 4.5 Satisfied (51 Votes)
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