Insurance Affidavit Template for England and Wales

An Insurance Affidavit is a sworn legal document that you must complete when your insurance company requires formal testimony to support your claim. This notarized statement serves as your official declaration under oath about the facts surrounding your insurance claim, making you legally responsible for the accuracy of all information provided.

When do you need this document?

You typically need an Insurance Affidavit when filing claims involving significant losses, suspected fraud investigations, or when your insurance company requests additional verification. Property damage claims exceeding certain thresholds, theft claims requiring police reports, or disability insurance claims often trigger this requirement. If you're dealing with a disputed claim where the insurance company questions the circumstances, they may request an affidavit to clarify facts. Medical malpractice insurance claims and workers' compensation cases frequently require sworn statements to establish the validity of the claim.

Key legal considerations

Your Insurance Affidavit must be completely truthful, as false statements can result in criminal charges under federal and state fraud statutes. The Federal False Claims Act imposes severe penalties for fraudulent statements in insurance matters involving government programs, including fines up to three times the damages plus additional penalties. You should carefully review all information before signing, as perjury charges can apply if you knowingly provide false information. Include only facts you can personally verify, and avoid speculation or assumptions about events. If health insurance is involved, ensure compliance with HIPAA requirements when disclosing medical information. Consider consulting with an attorney before signing if your claim involves complex circumstances or significant monetary amounts.

Legal requirements in United States

Under United States law, your Insurance Affidavit must be notarized by a licensed notary public to be legally valid. The document must include your complete identification information, specific details about your insurance policy, and clear statements about the claim circumstances. Federal legislation including the Insurance Fraud Prevention Act requires truthful statements in all insurance-related documents, making false claims a federal offense. State insurance codes vary by jurisdiction but generally require affidavits to include specific language regarding penalties for perjury. The McCarran-Ferguson Act delegates primary insurance regulation to states, meaning you must also comply with your state's specific requirements for affidavit format and content. Some states require additional witness signatures or specific notarial language to ensure the document meets local legal standards.