Edit Insurance Claim Affidavit - LegalDocs.pk

I, [InsuranceDeponentFullNameUnique], son/daughter of [InsuranceDeponentFatherNameUnique], holding CNIC No. [InsuranceDeponentCNICUnique], resident of [InsuranceDeponentAddressUnique], do hereby solemnly affirm and declare as under:

1. That I am the claimant and deponent of this affidavit and fully competent to swear the same.

2. That I have obtained an insurance policy bearing Policy No. [InsurancePolicyNumberUnique] from [InsuranceCompanyNameUnique].

3. That the insured item/property/person is [InsuranceSubjectDetailsUnique].

4. That on [InsuranceIncidentDateUnique], an incident occurred namely [InsuranceIncidentDescriptionUnique], resulting in loss/damage.

5. That I have filed a claim with the insurance company for the said loss under Claim No. [InsuranceClaimNumberUnique].

6. That the information provided by me is true and correct and no material fact has been concealed.

7. That this affidavit is executed for the purpose of processing my insurance claim.

DEPONENT:

Signature: __________________________

Name: [InsuranceDeponentSignNameUnique]

CNIC: [InsuranceDeponentSignCNICUnique]

VERIFICATION:

Verified on oath at [InsuranceCityUnique] on this [InsuranceVerificationDateUnique] that the contents of this affidavit are true and correct to the best of my knowledge and belief.

DEPONENT:

Signature: __________________________

ATTESTATION:

Sworn and signed before me on this [InsuranceAttestationDateUnique] at [InsuranceAttestationPlaceUnique].

OATH COMMISSIONER / NOTARY PUBLIC

Signature & Seal: __________________________