The Sworn Proof of Loss Form is a mandatory document required by insurance companies in the Philippines when processing insurance claims. This document is used when an insured party needs to make a formal claim for losses covered under their insurance policy. It must be completed in accordance with the Insurance Code of the Philippines (Republic Act No. 10607) and relevant Insurance Commission circulars. The form serves as a sworn statement detailing the circumstances of the loss, the value of damages claimed, and includes various supporting documents such as photographs, receipts, and official reports. The document must be notarized in compliance with Philippine notarial laws, making it a legally binding declaration. It is typically submitted within the timeframe specified in the insurance policy and forms the primary basis for the insurance company's claim evaluation process.
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1. Declarant Information: Identification details of the person making the claim, including full legal name, address, contact information, and relationship to the insured property
2. Policy Information: Details of the insurance policy including policy number, type of coverage, period of coverage, and name of insurance company
3. Loss Overview: Basic information about when, where, and how the loss occurred
4. Property Description: Detailed description of the damaged/lost property, including ownership information and pre-loss condition
5. Loss Details: Comprehensive account of the loss event, including date, time, location, and circumstances
6. Value and Claim Amount: Statement of the total amount being claimed, including calculation basis and actual cash value
7. Other Insurance Declaration: Statement regarding any other insurance covering the same property
8. Verification and Oath: Formal declaration under oath that all statements are true and correct
9. Notarization Block: Space for notary public's authentication of the document
1. Police Report Reference: Required when loss involves theft, vandalism, or other criminal acts - includes police report numbers and investigating authority details
2. Third Party Involvement: Required when the loss involves third parties - details of other parties involved and their role in the incident
3. Mortgage Information: Required when the property has a mortgage - details of the mortgagee and their interest in the claim
4. Business Interruption Details: Required for commercial claims involving business interruption - includes calculation of business losses
5. Salvage Declaration: Required when there is salvageable property - details of remaining value and disposition of damaged property
1. Schedule A - Itemized List of Lost/Damaged Property: Detailed inventory of all items claimed, including description, purchase date, original cost, and estimated current value
2. Schedule B - Supporting Documentation Index: List of all supporting documents attached, such as receipts, photos, and repair estimates
3. Schedule C - Witness Statements: Compiled statements from witnesses, if any, regarding the loss incident
4. Appendix 1 - Photographs: Compiled photographs of damaged property and incident scene
5. Appendix 2 - Original Receipts: Copies of original purchase receipts, repair estimates, or replacement cost quotations
6. Appendix 3 - Official Reports: Copies of police reports, fire department reports, or other official documentation related to the loss
Find the exact document you need
Sworn Proof Of Loss Form
A notarized declaration of loss document used in Philippine insurance claims that details the nature, extent, and value of claimed losses under an insurance policy.
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Sworn Affidavit Of Claim
A legally binding sworn statement used in the Philippines to formally declare and document a claim against another party, executed before a notary public under Philippine law.
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