Insurance affidavit form 2025

1. Click ‘Get Form’ to open the insurance affidavit form in the editor.
2. Begin by entering your name, address, city/state/zip, and phone number in the Applicant Information section. Ensure all details are printed legibly.
3. Indicate your employment status by checking the appropriate box. If you are an employer, provide the number of employees you have.
4. Select the type of project from the provided options. This is a required field, so make sure to choose one that accurately reflects your work.
5. If applicable, fill out the workers’ compensation policy information section with your insurance company name, policy number, and job site address.
6. Attach any necessary documents such as a copy of your workers’ compensation policy declaration page if required.
7. Finally, sign and date the affidavit at the bottom to certify that all information provided is true and correct before submitting it to your local city or town office.

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