Affidavit of No Other Insurance - Pennsylvania

Download Affidavit of No Other Insurance - Pennsylvania PDF

Pennsylvania · Fillable PDF · Free

Insurers use this sworn statement to confirm a claimant has no other coverage for a loss, often in policy-limits settlements. Confirm whether other insurance covers the loss in your claim.

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Who this form is for

  • Confirm whether other insurance covers the loss in your claim.
  • Insurers use this sworn statement to confirm a claimant has no other coverage for a loss, often in policy-limits settlements.

What you'll need

  • Read this packet and check the receiving agency's required form.
  • Gather the names, dates and supporting records requested in this document.
  • Bring acceptable identification and any witnesses required by the packet.

How to complete it

  1. Swear before a notary Sign under oath before the notary with a current, government-issued photo ID.
  2. Give it to the insurer handling the claim.

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