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Sworn Affidavit & Proof Of Loss Statement Generator for the USA

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Key Requirements PROMPT example:

Sworn Affidavit & Proof Of Loss Statement

"I need a Sworn Affidavit & Proof of Loss Statement for an insurance claim regarding water damage to my retail store inventory that occurred on January 15, 2025, with an estimated loss value of $75,000, including witness statements from two employees who were present during the incident."

Document background
A Sworn Affidavit & Proof of Loss Statement is required when filing insurance claims for significant losses or damages. This document combines the legal weight of a sworn affidavit with detailed proof of loss information required by insurance companies. It is used across all U.S. jurisdictions and must comply with both federal and state-specific requirements. The document typically includes detailed descriptions of the loss event, itemized valuations, and supporting documentation. It serves as the primary evidence for insurance claims and can be used in subsequent legal proceedings if disputes arise.
Suggested Sections

1. Declaration Header: States that this is a sworn statement, includes state/jurisdiction

2. Affiant Information: Full legal name and contact details of person making the statement

3. Policy Information: Insurance policy details, policy number, coverage periods

4. Loss Details: Date, time, location, and nature of the loss

5. Value Statement: Detailed accounting of loss amount and basis for calculation

6. Verification Statement: Statement confirming truth of information under penalty of perjury

7. Signature Block: Signature, date, and notary section

Optional Sections

1. Declaration Header: States that this is a sworn statement, includes state/jurisdiction

2. Affiant Information: Full legal name and contact details of person making the statement

3. Policy Information: Insurance policy details, policy number, coverage periods

4. Loss Details: Date, time, location, and nature of the loss

5. Value Statement: Detailed accounting of loss amount and basis for calculation

6. Verification Statement: Statement confirming truth of information under penalty of perjury

7. Signature Block: Signature, date, and notary section

Suggested Schedules

1. Schedule A - Itemized Loss List: Detailed inventory of lost/damaged items with values

2. Schedule B - Supporting Documentation: Receipts, photos, repair estimates, police reports

3. Schedule C - Ownership Documentation: Proof of ownership for claimed items

4. Schedule D - Expert Reports: Professional assessments or appraisals if applicable

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓƵ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Clauses

























Industries

Federal Rules of Evidence - Rule 603: Governing requirements for oaths and affirmations in federal proceedings, ensuring that every witness before testifying must give an oath or affirmation to testify truthfully

18 U.S.C. ยง 1621: Federal perjury statutes defining penalties for willfully making false statements under oath

U.S. Code Title 15: Federal regulations governing commerce and trade, including insurance-related provisions and requirements

State Insurance Codes: State-specific regulations governing insurance claims, procedures, and requirements for proof of loss documentation

State Notary Laws: Requirements for proper notarization of documents, including specific state guidelines for witnessing and authenticating sworn statements

State False Statement Laws: State-specific statutes regarding penalties for making false statements in legal documents and insurance claims

Proof of Loss Time Requirements: State-specific deadlines and time limitations for filing proof of loss statements with insurance companies

Insurance Industry Documentation Standards: Standard industry requirements for documentation, evidence, and supporting materials in proof of loss claims

Affidavit Format Requirements: Legal formatting requirements for sworn affidavits, including necessary components such as venue, jurisdiction, and personal knowledge statements

Fair Claims Settlement Practices Acts: State laws governing insurance companies' claims handling practices and protecting consumers' rights during the claims process

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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