Affidavit of Eligibility
Affidavit of Eligibility
Introduction
I, [YOUR NAME], being duly sworn, depose and state as follows:
-
I am over the age of eighteen (18) years and am fully competent to make this affidavit.
-
I am making this affidavit in connection with an insurance claim filed with [INSURANCE COMPANY NAME] for [NATURE OF INSURANCE CLAIM].
State of Facts
-
I am the insured individual under policy number [POLICY NUMBER], issued by [INSURANCE COMPANY NAME].
-
On [DATE OF INCIDENT], [DESCRIBE THE INCIDENT LEADING TO THE INSURANCE CLAIM].
-
As a result of the aforementioned incident, I have incurred [SPECIFY THE TYPE AND AMOUNT OF DAMAGES OR LOSSES INCURRED].
-
I have attached hereto copies of all relevant documents, including but not limited to, the insurance policy, the claim form, and any supporting documentation.
Sworn Oath
I solemnly swear that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I understand that making false statements in this affidavit is punishable by law.
[YOUR NAME]
STATE OF [STATE]
COUNTY OF [COUNTY]
Subscribed and sworn to before me this [DAY] day of [MONTH], [YEAR].
[NOTARY PUBLIC NAME]
[NOTARY PUBLIC COMMISSION EXPIRATION DATE]
