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Sworn Statement of Loss, Vehicle

Sworn Statement of Loss, Vehicle TO: ____________________ Regarding: __________________ Policy number: __________________ Policy period: _________________ to __________________ By the above-mentioned policy of insurance, you insured __________________, (hereinafter called the insured) against loss or damage to the automobile described as follows: Model Year: __________________ Make: ________________ Type of body: _________________ VIN: ___________________ State/License number: _______________ _________ […]