Car Insurance Declaration

I, [YOUR NAME], currently residing at [YOUR ADDRESS], hereby declare the following with respect to my car insurance policy with [YOUR INSURANCE COMPANY NAME]. My policy number [YOUR POLICY NUMBER] effectively covers the vehicle with the identification number (VIN) [YOUR VEHICLE VIN]. This declaration is aimed to confirm the details as per the records of [YOUR INSURANCE COMPANY NAME] and to affirm my commitment to the compliance requirements set forth by the applicable regulations and policies.

I. Personal Information

Full Legal Name: [YOUR NAME]
Contact Information: [YOUR PHONE NUMBER], [YOUR EMAIL]
Address: [YOUR ADDRESS], which is my current residence and the principal location where the insured vehicle is stored.

II. Vehicle Details

Make and Model of Vehicle: [YOUR VEHICLE MAKE AND MODEL]
Vehicle Identification Number (VIN): [YOUR VEHICLE VIN]
Year of Manufacture: [VEHICLE MANUFACTURE YEAR]

The vehicle is primarily used for [TYPE OF USAGE] and is insured against both accidents and theft under the policy number [YOUR POLICY NUMBER].

III. Insurance Policy Details

Insurance Company: [YOUR INSURANCE COMPANY NAME]
Policy Number: [YOUR POLICY NUMBER]
Effective Dates of Policy: From [POLICY START DATE] to [POLICY END DATE]
Type of Coverage: [TYPE OF COVERAGE] which includes [COVERAGE DETAILS]
Annual Premium: [ANNUAL PREMIUM AMOUNT]

The said insurance policy is in full compliance with the laws and regulations of the state in which the vehicle is registered ([YOUR VEHICLE REGISTRATION STATE]).

IV. Declaration

I hereby affirm that all the information provided here is accurate and true to the best of my knowledge. I agree to abide by the terms set forth in the insurance agreement and acknowledge that any false declaration or violation may lead to implications as defined under the policy terms including potential cancellation of the policy.

V. Signature

[YOUR NAME]
Date: [DATE OF SIGNING]