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Sworn Proof Of Loss Form
"I need a Sworn Proof of Loss Form for an insurance claim related to flood damage at my manufacturing facility in Manchester, with an estimated loss value of £250,000, which occurred on January 15, 2025, under policy number MAN-2024-789."
1. Declaration Header: States document type and jurisdiction, including statutory declaration format
2. Claimant Information: Full details of the person/entity making the claim including name, address, contact details, and relationship to insured property
3. Policy Details: Insurance policy number, type, coverage details, insurer information, and policy period
4. Loss Description: Detailed account of the loss event, date, time, location, circumstances, and cause of loss
5. Loss Amount: Itemized breakdown of claimed losses, including values and basis of calculation
6. Verification Statement: Sworn statement confirming truth of information provided, with statutory declaration wording and warning about perjury
1. Additional Insurers: Details of other insurance policies covering the loss, including policy numbers and insurers
2. Third Party Claims: Information about related third-party claims or potential claims arising from the same incident
3. Salvage Details: Information about salvaged property, including condition and current location
1. Schedule A - Supporting Documentation: List and copies of attached evidence supporting the claim (receipts, invoices, reports)
2. Schedule B - Itemized Loss Calculation: Detailed breakdown of loss amounts with calculations, including depreciation if applicable
3. Schedule C - Photographs: Visual evidence of damage or loss, with dates and descriptions of each photograph
Authors
Insured
Insurer
Loss Event
Date of Loss
Property
Claim Amount
Actual Cash Value
Replacement Cost
Deductible
Supporting Documentation
Salvage
Other Insurance
Jurisdiction
Coverage Period
Declaration
Verification
Policy Period
Premises
Damaged Property
Cause of Loss
Time of Loss
Location of Loss
Interest of Insured
Encumbrances
Changes in Risk
Previous Claims
Proof of Loss
Policy Details
Loss Description
Time and Place
Cause of Loss
Value and Damage
Other Insurance
Ownership and Interest
Changes to Risk
Previous Claims
Supporting Evidence
Salvage Rights
Subrogation
Penalties for False Statements
Documentation Requirements
Payment Instructions
Assignment
Limitation of Liability
Privacy and Data Protection
Jurisdiction
Attestation
Notarization
Claim Amount
Third Party Rights
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