AFFIDAVIT IN SUPPORT OF A PROPERTY / FIRE INSURANCE CLAIM
I, __________, __________, aged about __________ years, resident of __________, __________, do solemnly affirm and state on oath as follows.
- 1. THE POLICYHOLDER AND THE POLICY
- 2. THE LOSS
- 4. AMOUNT OF THE LOSS
- 5. TITLE TO THE PROPERTY OR GOODS LOST OR DAMAGED
- 6. NO OTHER OR PRIOR CLAIM ON THIS LOSS
- 7. PENDING PROCEEDINGS
No suit, complaint or other proceeding relating to the insured property, to the loss described in this affidavit, or to the claim made on it, is pending before any court, police authority, consumer forum, the Insurance Ombudsman, or other authority — except only as disclosed under the heading DISCLOSURE in this paragraph.
- 9. UNDERTAKING AND INDEMNITY
ANNEXURE INDEX
THE PAPERS FILED WITH THIS AFFIDAVIT
VERIFICATION
JURAT
_______________________________
NOTARY PUBLIC / OATH COMMISSIONER / EXECUTIVE MAGISTRATE
(Signature, seal, registration number, and serial number in the notarial register)
This notice is given under the Digital Personal Data Protection Act, 2023.
If the claim is withdrawn, rejected or closed without payment, personal data will be retained for 90 days and then erased. If the claim proceeds to payment, the record will be retained for the claim/transaction term plus 12 months, except where a named statutory or regulatory record-retention period requires longer retention.
Data minimisation: this document does not collect a full Aadhaar number, an Aadhaar-card copy, a password, or bank credentials, and none should be written into it. Use masked account or identity references where an identifying reference is genuinely necessary.