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  • Sworn Statement In Proof Of Loss Form Example

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Sworn Statement in Proof of Loss This form is provided to comply with the Insurance Act, where required, and without prejudice to the liability of the Insurer. Claim Number Insurer Name Address Name.

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A “proof of loss” is a document filled out by the policyholder when property damage occurs resulting in an insurance claim. This form helps to substantiate the value of the insured's loss to the insurance company.

A sworn proof of loss is a statement completed by an insured under oath which provides information relevant to the alleged damage to the insured's property. Most policies require an insured to complete a sworn proof of loss shortly after the loss occurred (e.g., within 30 to 60 days of the loss).

A Sworn Statement in Proof of Loss outlines the basic details of your property damage claim and serves as a cover document for your supporting claim materials and documentation.

What Is a Sworn Statement in Proof of Loss? A sworn statement in proof of loss is a formal statement most insurance companies required you file a compensation claim. The document prevents insurance fraud by substantiating the value of the insured's costs through official documentation and a notarized signature.

Evidence of the loss, e.g. photos, receipts, police report, etc. Replacement value of items damaged or destroyed. Estimates to repair damage caused to the property. Documentation that supports the amount claimed.

If a tornado strikes a town and takes the roof off the building, a direct loss would include damage to the structure, as well as to equipment, furniture, inventory or other items inside. Fire and smoke damage would count as a direct loss. So would theft, or a car crashing through the front window.

For example, they usually spend $100 a week on food. However, because they are living in a hotel, they end up spending $400. While they will not get the full reimbursement of $400, they will get the actual loss, which is only $300 ($400 - $100 = $300).

6 Steps to Fill Out a Proof of Loss Document The date and cause of the loss. Coverage amounts at the time the loss occurred. Documents that support the value of your property and the amount of loss you claim such as estimates, inventories, receipts, etc. Policy number. Parties that have an interest in the property.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232