Sworn Statement of Loss, General
A Sworn Statement in Proof of Loss, basically,is a document that may be requested to submit following a claim on property loss. The purpose of the Proof of Loss is to obtain a formal statement from the policyholder regarding the reason behind the property loss. Insurance companies use this proof of loss to determine the circumstances and their liabilities for the asset 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 and in some, the description of the policy is also stated. Your factual statement regarding the date, time, origin and cause of loss must definitely be reasonable and in all terms and conditions bona fide. Essential information to include also, of course, is the specifications of the property claimed to be loss. The actual cash value of the said property at the time of loss and the whole loss and damage is also to be filled up. 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, General
Sworn Statement of Loss
Date policy issued: ___________________
Date policy expires: __________________To the ___________________________________. At time of loss, by the above indicated policy of insurance you insured:
_________________________________________________________ against loss by __________________________, upon the property described by the under Schedule “A,” according to the terms and conditions of the same policy and all forms, endorsements, transfers and assignments attached thereto.Time and origin: A ____ loss occurred about the hour of ____ __m., on the _______. The cause and origin of said loss were:
_______________________________________________________________Occupancy: The building described or containing the property described, was occupied at the time of the loss as follows, and for no other purpose whatever:
_____________________________________________________________Title and Interest: At the time of the loss the interest of your insured in the property described therein was _________.
Changes: Since the said policy was issued there has been no assignment thereof, or change of interest, use, occupancy, location or exposure of the property described, except: ______.
Total insurance: The total amount of insurance upon the property described by this policy was, at the time of the loss, $ _______ (____________&___/100 Dollars) as more particularly specified in the apportionment attached under Schedule “C,” besides which there was no policy or other contact of insurance, written or oral, valid or invalid.
The actual cash value of said property at the time of the loss was $ _______ (____________&___/100 Dollars). The Whole Loss and Damage was $ ________ (___________ & ___/100 Dollars)
The amount claimed under the above numbered policy is $ _________ (____________&___/100 Dollars) The said loss did not originate by any act, design or procurement on the part of your insured, or this affiant; nothing has been done by or with the privity or consent of your insured or this affiant, to violate the conditions of the policy, or render it void; no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss; no property saved has in any manner been concealed, and no attempt to deceive the said company as to the extent of said loss, has in any manner been made. Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of its rights.
State of ___________
County of __________Subscribed and sworn to before me this ______ day of __________ 19______.
_____________________________________________
Notary
My Commission Expires:Sworn Statement of Loss
Review ListThis review list is provided to inform you about this document in question and assist you in its preparation. This document is necessary on occasion to get paid on an insurance claim. It is also of use if you are self-insured and want to collect a deduction on your tax form from the IRS and your state authorities.
1. Make multiple copies. Get them notarized. Official bodies like the IRS and insurance companies like official looking documents. So do it.
Frequently Asked Questions
What is a sworn statement of loss?
A sworn statement of loss is a formal document used in insurance claims to provide details about a loss under a policy. It includes information such as the policy dates, the insured property, the cause and origin of the loss, and the occupancy of the building. The statement is typically sworn to by the insured and serves as an official record of the claim.
What information is required in a sworn statement of loss?
The sworn statement of loss requires details such as the policy issue and expiration dates, the name of the insured, the property insured, the cause of loss, the time and origin of the loss, the occupancy of the building, and the insured's interest in the property. It also asks for confirmation that there have been no changes to the policy or property since it was issued. All this information is provided under oath.
When is a sworn statement of loss needed?
A sworn statement of loss is typically required by an insurance company after a loss occurs to verify the details of a claim. It is often a condition of the policy that the insured must submit this statement to receive payment for covered losses. The exact timing depends on the policy terms and the insurer's request.
Who fills out a sworn statement of loss?
The insured person or entity named in the policy is responsible for filling out and swearing to the sworn statement of loss. In some cases, a representative or legal counsel may assist, but the statement is made by the insured. It must be signed under oath, meaning the insured attests to the truthfulness of the information.
What does occupancy mean in a sworn statement of loss?
In a sworn statement of loss, occupancy refers to how the building described in the policy was being used at the time of the loss. The form requires the insured to specify the exact use, such as residential or commercial, and states that it was used for no other purpose. This helps the insurer assess whether the risk aligns with the policy terms.
What is title and interest in a sworn statement of loss?
Title and interest in a sworn statement of loss refers to the insured's ownership or financial interest in the property at the time of the loss. The insured must state the nature of their interest, such as owner or mortgagee. This information helps the insurer determine the extent of coverage and prevent fraud.
What changes must be reported in a sworn statement of loss?
The sworn statement of loss requires the insured to confirm that since the policy was issued, there has been no assignment of the policy or change in interest, use, occupancy, location, or exposure of the property. If any such changes occurred, they must be disclosed. This ensures the insurer is aware of any factors that could affect the risk.
Why is a sworn statement of loss important for an insurance claim?
A sworn statement of loss is important because it provides the insurer with a verified account of the loss, which is necessary to process the claim. It helps prevent fraudulent claims and ensures that the insured has complied with policy conditions. Without it, the insurer may delay or deny payment.
What happens if I don't submit a sworn statement of loss?
If you fail to submit a sworn statement of loss as required by your policy, the insurance company may delay or deny your claim. The policy likely includes this as a condition for coverage, so non-compliance can jeopardize your right to payment. It is essential to complete and return the statement promptly when requested.
Is a sworn statement of loss legally binding?
Yes, a sworn statement of loss is legally binding because it is made under oath. The insured attests that the information provided is true and complete, and providing false information could constitute fraud. This legal weight encourages accuracy and honesty in the claims process.
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