Instructions for a Sworn Statement in Proof of Loss

A sworn statement in proof of loss is important in insurance claims.

If you have made a claim through your insurance company, you may be asked to fill out a sworn statement in proof of loss. This document is intended to reduce instances of insurance fraud. These statements vary, depending on the insurance company and type of policy, but generally you will be affirming that your property or items were destroyed and should be covered by your insurance policy. A sworn statement in proof of loss is relatively simple to complete.


Step 1

Obtain a copy of the required sworn statement from your insurance company. It should be entitled "Sworn Statement in Proof of Loss."

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Step 2

Review a copy of your insurance policy. You will need the information from your policy when you fill out your sworn statement in proof of loss.


Step 3

Write down your policy number, the coverage amount, the name of your insurance agent, the insurance agency, and the issue and expiration dates of your policy. Include your case number if you have one.

Step 4

Fill out your insurance company's name on the line following "To the." Add the town where your insurance company is located after the word "of" in the first line of the statement. For example, "To the State Farm Insurance of Portland, Oregon."


Step 5

Add your name and address in the next section. Indicate what caused damage to your property on the following line. For instance, you would write "fire" or "theft."


Step 6

Complete the "Time or Origin" section of the sworn statement. Add the time and date of the loss. Fill in the purpose of your property under "occupancy." For instance, if the property is your primary residence, list "residency" on the line provided.


Step 7

Estimate the monetary amount of damages. Include the total amount of insurance and the value of the property.

Step 8

Bring the sworn statement to a notary public. Sign and date your name in front of the notary. The notary will fill in the remaining information. Return the sworn statement to the insurance company.


Your insurance agent can also help you fill out your sworn statement in proof of loss.

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