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Sworn Statement of Loss Insurance

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This is a sworn statement of loss to be sent to an insurance carrier in connection with a claim. The statement provides the type of loss and the damage that occurred to property. In addition, the policyholder must provide the insurance policy number, the date the policy was issued, and the date the policy expires. This statement must be certified by a notary public to ensure the proper identification of the policyholder. This statement can be used by individuals or entities that want to provide a statement of loss to their insurance carrier.

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