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Sworn Statement Of Loss, Vehicle

Free Printable Sworn Statement Of Loss, Vehicle FormFree Printable Sworn Statement Of Loss, Vehicle Form

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

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 List

This 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.

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