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Insurance Affidavit

Insurance Affidavit Template for Indonesia

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Key Requirements PROMPT example:

Insurance Affidavit

"I need an Insurance Affidavit to support my property damage claim resulting from the January 15, 2025 flooding event in Jakarta, including photographs and repair cost estimates for my manufacturing facility."

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Document background
The Insurance Affidavit is a crucial document in Indonesian insurance practice that serves as a formal, sworn statement providing verified information about insurance-related matters. This document type is commonly used when formal verification of insurance-related facts is required, such as during claims processing, policy disputes, or regulatory compliance procedures. The affidavit must be executed in accordance with Indonesian law, particularly Law No. 40 of 2014 on Insurance and relevant OJK regulations, and requires notarization to be legally valid. Insurance Affidavits can be used across various scenarios, including but not limited to confirming policy details, documenting loss circumstances, verifying beneficiary information, or attesting to the authenticity of insurance-related documents. The content and format must comply with Indonesian legal requirements for sworn statements while addressing specific insurance-related matters at hand.
Suggested Sections

1. Title and Jurisdiction: Clearly states this is an Insurance Affidavit and the jurisdiction (Indonesia)

2. Affiant Information: Full legal name, identification details, address, and capacity of the person making the affidavit

3. Oath Declaration: Formal declaration that the statements are being made under oath and subject to penalties of perjury

4. Insurance Policy Details: Specific information about the insurance policy including policy number, type, issuer, and relevant dates

5. Statement of Facts: Detailed enumeration of the facts being sworn to, presented in clear, numbered paragraphs

6. Supporting Evidence Reference: References to any supporting documents or evidence being attached to the affidavit

7. Verification Statement: Affiant's confirmation that all stated information is true and correct to the best of their knowledge

8. Execution Block: Space for affiant's signature, date, and notary's authentication

Optional Sections

1. Additional Witness Statements: Section for additional witnesses to provide supporting sworn statements, used when multiple parties need to testify to the same facts

2. Prior Claims History: Details of any previous insurance claims, used when relevant to the current affidavit

3. Medical Information: Specific section for health-related information, used in health insurance or injury-related affidavits

4. Property Details: Detailed description of property, used in property insurance-related affidavits

5. Financial Loss Statement: Detailed breakdown of financial losses, used in claims-related affidavits

Suggested Schedules

1. Schedule A - Supporting Documents: List and copies of all referenced supporting documents (insurance policies, correspondence, etc.)

2. Schedule B - Photographic Evidence: Photographs or visual evidence referenced in the affidavit, if applicable

3. Schedule C - Official Reports: Copies of any official reports (police reports, medical reports, etc.) referenced in the affidavit

4. Schedule D - Correspondence: Copies of relevant correspondence with insurance companies or other parties

5. Appendix 1 - Certified Translations: Official translations of any documents not in Indonesian or English, if required

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions



























Clauses
























Relevant Industries

Insurance

Financial Services

Legal Services

Healthcare

Real Estate

Manufacturing

Transportation

Construction

Retail

Maritime

Aviation

Agriculture

Relevant Teams

Legal

Compliance

Risk Management

Claims Processing

Underwriting

Policy Administration

Corporate Secretariat

Regulatory Affairs

Insurance Operations

Document Management

Relevant Roles

Insurance Claims Manager

Risk Manager

Compliance Officer

Legal Counsel

Insurance Underwriter

Claims Adjuster

Insurance Broker

Policy Administrator

Insurance Agent

Corporate Secretary

Risk Assessment Officer

Legal Documentation Specialist

Insurance Operations Manager

Regulatory Affairs Manager

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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