Free Proof-of-Loss Form

Important Info about this Form (read before downloading)

A sworn statement in proof of loss — often just called a Proof of Loss or POL — is a signed document that you or your representative submits to an insurance provider to formally attest to the amount and scope of losses for which you are owed reimbursement. Most insurance policies require you to submit a proof of loss if your insurance provider asks for it. But even if your insurance company doesn’t ask for a proof of loss, it’s often still a good idea to submit one because doing so puts the onus your insurance company to pay on your claim or to explain why it is denying your claim. In some states, submitting a proof of loss also triggers official deadlines for the insurance company to respond to your claim. For all of these reasons, a proof of loss is one of the most powerful tools in the policyholder’s toolbox (see Proof of Loss: The Ultimate Guide).

To help property owners submit a proof of loss, Brelly is happy to offer an example of a proof of loss form that is downloadable for free. It’s important to emphasize that this is a generic POL form. We selected it because we know professionals who have successfully used it in the field, but we cannot guarantee that is suited for every possible situation or scenario. In particular, if your insurance company gave you a specific form to use for your proof of loss, you should use that form. This is especially true if your insurance policy specifically requires you to use the insurance company’s form. Consult the duties-after-loss provision of your policy to learn more. Also, this form is not specific to any state. If you want a POL form that’s specific to a state, see our listing of other POL forms.