Sworn Statement and Proof of Loss (PDF) - City of Lorain 2025

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How to Fill out a Sworn Statement in Proof of Loss Obtain a copy of the Sworn Statement in Proof of Loss from the insurance company. Fill out the required information, including the policy number, insurance agents name, insurance agency, and the issue and expiration dates for the policy.
A sworn statement in proof of loss represents a formal document that many insurance companies require before processing a claim. The formal document attempts to prevent insurance fraud by verifying the value of every insured cost listed within an insurance claim.
The following are six critical sections that must be included: Title. This is either your name (Affidavit of Jane Doe) or the specific case information. Statement of identity. The next paragraph tells the court about yourself. Statement of truth. Statement of facts. Closing statement of truth. Sign and notarize.
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