Important Info about this Form (read before downloading)
A “proof of loss” — sometimes called a “sworn statement in proof of loss,” or POL — is typically a signed or sworn statement that reports the loss and the amount you’re claiming under the policy. It puts your position in one place, but it does not decide what the policy covers or prove that every dollar claimed is payable. Your policy may require a proof after the insurer asks for one, and the controlling instructions may set the form, deadline, attachments, permitted signer, signature or notary steps, and delivery method. I still think a carefully prepared proof can be one of the most powerful tools in a policyholder’s toolbox. Whether to submit one before it is requested is a claim-specific decision, though — check the policy, the insurer’s instructions, and any state or federal-program rules first. Florida law is one reason to keep those triggers straight: receiving a proof of loss can start duties that are different from the payment-decision clock triggered by notice of the claim. For the full process, including evidence, deadlines, and follow-up, see Proof of Loss: The Ultimate Guide.
This Florida-labeled, two-page blank is a generic POL form. In the August 2023 file, the warning required by Florida §626.8797 appears in bold 18-point type before the insured-signature spaces. That matches the statute text checked on August 3, 2026, but it is only one feature of the file — not approval of the whole form. The blank does not identify your carrier, policy edition, insurance line, federal program, or claim-specific request; its two insured-signature areas and notary block are features of this file, not proof that every user needs two signatures or notarization. The August PDF is printable and text-extractable, but it is not interactively fillable, so you would need to print and complete it by hand or use an external annotation workflow unless the file is remediated. Before using it, compare every instruction with the insurer’s request and your policy’s duties-after-loss language. Florida law also lets a person claiming a loss under an insurer’s contract request proof-of-loss forms from the insurer in writing; the insurer must furnish the forms, but is not responsible for completing them or for how they are completed. If your insurer supplies a specific form, or your policy or program requires one, use that form unless qualified claim-specific advice establishes an accepted alternative. NFIP and WYO flood claims follow the federal flood program’s rules, so a Florida warning does not make this blank an NFIP proof-of-loss form. Finally, this form is specifically labeled for use in Florida. If the loss is outside Florida, you can review Brelly’s state-neutral proof-of-loss form, but “state-neutral” does not mean universal — verify the insurer, policy, state, and program requirements before signing it.
