Important information about this form (read before downloading)

A proof of loss—sometimes called a sworn statement in proof of loss, or POL—is typically a formal statement that reports the loss and the amount claimed under an insurance policy. Depending on the policy, form, insurance line, state rule, or federal program, it may need to be signed, sworn, supported with specific records, or delivered by a particular deadline. It gives the insurer information to evaluate; it does not by itself establish coverage, prove that every amount is owed, or trigger one universal response clock. I still think a carefully prepared proof can be one of the most powerful tools in a policyholder's toolbox, but only when it fits the claim and is supported by the record. Check the controlling instructions before submitting one voluntarily. For the fuller process, including evidence, deadlines, and follow-up, see Proof of Loss: The Ultimate Guide.

This Oklahoma-labeled Brelly form is a generic POL form. It does not identify your carrier, policy edition, insurance line, federal program, or claim-specific request. If your insurance company gives you a specific proof-of-loss form, or your policy or program requires one, use that form. Before substituting another blank, confirm with the insurer or program administrator that it will be accepted, and keep that confirmation.

Check your policy's duties-after-loss language and the insurer or program instructions for:

  • the deadline;
  • the required information and attachments;
  • who may sign, including any signature or notary steps; and
  • the accepted delivery method.

Oklahoma §36-4805 is not a free-standing 60-day rule for every claim. When a policy subject to Article 48 contains a provision requiring a written sworn proof within 60 days, or law requires that proof, an insurer cannot assert the failure in litigation unless it pleads and proves the section's conditions. Those include furnishing two blank forms, providing the specified conspicuous warning on the forms or in an accompanying letter, and executing and furnishing a written extension giving 60 days from the insured's receipt of the blanks. The short §36-4805 sentence printed in this PDF does not supply all of that context or establish that the section governs your policy.

The September 2023 file is printable and text-extractable but not interactively fillable, so it would require hand completion or an external annotation workflow unless remediated. Its Oklahoma label and document tags do not make the whole form approved, accessible, current for every claim, or suitable for NFIP flood claims.

Finally, this form is specifically labeled for use in Oklahoma. For a loss outside Oklahoma, Brelly's state-neutral form is another example to evaluate—not a universal substitute for the insurer, policy, jurisdiction, or program requirements.