Sworn Statement of Loss, Vehicle
A Sworn Statement in Proof of Loss is a document that may be requested to submit following a property loss claim – in this case, a vehicle. The purpose of the Proof of Loss is to obtain a formal statement from the policyholder regarding the reason behind the vehicle loss. Insurance companies use this proof of loss to determine the circumstances and their liabilities for the vehicle loss. Filing a sworn statement of loss is beneficial on the part of the policyholder for it would be an aspect for the recovery of your vehicle. Well, depending on the agreed policy with your insurance company and the way it was worded, that is.
Information to be included in the form is your personal data and proof of ownership. The person to be addressed regarding the matter must also be in the document. Since a sworn statement of loss is to be handed on to your insurance company, the policy number and the duration of the policy must be stated. Your factual statement regarding the date and cause of loss, your estimate of the vehicle loss and documents that support your loss estimate and amount of claim submitted must definitely be reasonable and in all terms and conditions bona fide. Essential information to include, of course, are the specifications of the vehicle claimed to be loss. The document is then to be signed by the notary public for legalities.
The bottom line is that all the statements in the Sworn Statement of Lost must be true and reasonable. Yes, it is just a single piece of paper but this piece of paper is very important. A Sworn Statement of Loss must be filed properly and in a timely manner for the insurance company can deny the said claim. Therefore, assistance from an attorney is essential so as to tell you what is really needed in the Sworn Statement of Loss.
Sworn Statement Of Loss, Vehicle
Sworn Statement of Loss, Vehicle
TO: ____________________
Regarding: __________________
Policy number: __________________
Policy period: _________________ to __________________By the above-mentioned policy of insurance, you insured __________________, (hereinafter called the insured) against loss or damage to the automobile described as follows:
Model Year: __________________
Make: ________________
Type of body: _________________
VIN: ___________________
State/License number: _______________ _________A loss caused by __________________ occurred on ________________, about the hour of _________________ __________, as follows:
__________________The insured was the sole owner of the automobile at the time of the loss or damage and no other person had any interest therein, by lease, bailment, mortgage, lien or other encumbrance or otherwise except:
___________________At the time of this loss, there was no other insurance on said automobile covering the same periods except:
__________________At the time of this loss, the automobile was used for:
___________________and was not being used to carry passengers or for compensation or rental or leased, or for any illegal or non-covered loss except:
__________________The said loss or damage did not originate by any act, design or procurement on my (our) part nor on the part of anyone having an interest in the party insured, or in the said policy of insurance; not in result or consequence of any fraud done or suffered by me/us and that no property saved has been concealed.
It is expressly understood that the furnishing of this blank or the preparation of this proof by a representative of the above insurance company, ____________________, is not a waiver of any of its rights.
_______________________________________________________
__________________ By Owner
State of ________________________
County of _______________________Sworn to and subscribed before me on ___________________________________________.
_______________________________________________________
Notary Public
My Commission Expires:Sworn Statement of Loss, Vehicle
Review ListThis review list is provided to inform you about this document in question and assist you in its preparation. This statement is useful both for insurance claims and tax deductions for loss on your IRS and state forms.
Use a notary. Large organizations like the niceties of this approach.
Frequently Asked Questions
What is a Sworn Statement of Loss for a vehicle?
A Sworn Statement of Loss for a vehicle is a formal document used in insurance claims to provide a detailed account of a loss or damage to an automobile. It includes information such as the policy details, vehicle identification, and the circumstances of the loss. The statement is sworn, meaning it is made under oath and must be truthful.
When is a Sworn Statement of Loss required?
A Sworn Statement of Loss is typically required by an insurance company when processing a claim for vehicle damage or loss. It serves as an official record of the incident and helps the insurer verify the details of the claim. The specific timing depends on the insurer's requirements, but it is usually requested during the claims process.
What information do I need to provide in a Sworn Statement of Loss for a vehicle?
You need to provide the policy number, policy period, and details of the insured vehicle such as model year, make, body type, VIN, and license number. You must also describe the loss, including the cause, date, time, and circumstances. Additionally, you must disclose any other interests in the vehicle, other insurance, and how the vehicle was being used at the time of loss.
Who needs to sign a Sworn Statement of Loss?
The insured person, as named in the policy, is typically required to sign the Sworn Statement of Loss. The statement is made under oath, so the signer must affirm that the information provided is true and accurate. In some cases, additional parties with an interest in the vehicle may also need to sign.
What happens if I provide false information on a Sworn Statement of Loss?
Providing false information on a Sworn Statement of Loss can have serious consequences, including denial of the claim and potential legal action for insurance fraud. Since the statement is sworn, it is made under oath, and false statements may constitute perjury. It is essential to be truthful and accurate when completing the form.
What does 'sole owner' mean in a Sworn Statement of Loss?
In a Sworn Statement of Loss, 'sole owner' means that the insured is the only person with ownership interest in the vehicle. The statement requires disclosure of any other interests, such as leases, bailments, mortgages, liens, or other encumbrances. If there are no other interests, the insured confirms that no other person has any interest in the vehicle.
What should I list for 'other insurance' on a Sworn Statement of Loss?
You should list any other insurance policies that cover the same vehicle for the same period as the loss. If there is no other insurance, you would indicate that none exists. This information helps prevent duplicate claims and ensures proper coordination of benefits.
How do I describe the use of the vehicle at the time of loss?
You need to state how the vehicle was being used at the time of the loss, such as personal, business, or commuting purposes. The form also requires confirmation that the vehicle was not being used to carry passengers for compensation, rental, or lease, or for any illegal or non-covered purposes. This helps the insurer determine coverage applicability.
What is the purpose of the Sworn Statement of Loss form?
The purpose of the Sworn Statement of Loss form is to provide the insurance company with a verified account of the loss or damage to the vehicle. It helps the insurer assess the claim, determine coverage, and detect potential fraud. The sworn nature of the statement adds a layer of accountability for the insured.
Can I fill out a Sworn Statement of Loss electronically?
The article does not specify whether the Sworn Statement of Loss can be filled out electronically. Typically, such forms may require a physical signature, but this can vary by insurance company. It is best to check with your insurer for their specific procedures.
Omg don’t tell me this is for free.
Thank you so much for doing this it really helps alot
Very well written template…Thank you!
Going to used this form today.Thanks
The printable form itself is as impressive as you can get to paid one.
Wonderful template. im going to print this form and will talk together with my family on what to edit.
Wow, thanks, The template looks professional done, printing myself one now.
Thank you very much 🙂 . I need this badly. Thank you im glad i found you on Google 🙂
Thank you! This document is very helpful to my business.
That is BRILLIANT!!! admin, you just made my year even more worth while for me!