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01. Edit your insurance affidavit template online
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Send affidavit of self accident via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out insurance affidavit form with our platform
- Click ‘Get Form’ to open the insurance affidavit form in the editor.
- Begin by entering your name, address, city/state/zip, and phone number in the Applicant Information section. Ensure all details are printed legibly.
- Indicate your employment status by checking the appropriate box. If you are an employer, provide the number of employees you have.
- 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.
- If applicable, fill out the workers’ compensation policy information section with your insurance company name, policy number, and expiration date.
- Attach a copy of your workers’ compensation policy declaration page as instructed.
- Finally, certify that the information provided is true by signing and dating the form before submission.
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