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2340 F6/page 1 of 1 STATEMENT OF INSURANCE ON PRIVATE VEHICLES Required by F.S. 234.03 (4) School Year School Date The School Board of Brevard County, Florida requires proof of insurance coverage
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How to fill out a statement of insurance:

01
Gather all necessary information: Before filling out the statement of insurance, make sure you have all the relevant details ready. This includes your personal information, policy number, and details about the incident or claim you are filing for.
02
Start with personal details: Begin by providing your full name, address, contact information, and any other requested personal details. This information helps the insurance company identify you and your policy.
03
Policy information: Include your policy number, policy type, and the effective dates of your coverage. This ensures that the insurance company knows the specific policy under which you are filing the claim.
04
Describe the incident or claim: Clearly explain the details of the incident or claim you are filing for. Be as specific as possible, providing dates, times, locations, and any other relevant information. This helps the insurance company understand the nature and circumstances of the claim.
05
List any additional parties involved: If there are any other individuals or parties involved in the incident, provide their names, contact information, and any other relevant details. This is important for the insurance company to assess liability or determine if there are multiple claims related to the incident.
06
Provide supporting documents: Attach any supporting documents that can validate your claim. This may include photographs, police reports, medical records, repair estimates, or any other pertinent evidence. Make sure to label and organize the documents to make it easier for the insurance company to review.
07
Sign and date the statement: Once you have completed all the necessary sections, sign and date the statement of insurance. Your signature confirms that the information provided is accurate to the best of your knowledge.

Who needs a statement of insurance:

01
Individuals filing insurance claims: Anyone who needs to make a claim for an insured incident will typically need to complete a statement of insurance. This applies to various types of insurance such as auto insurance, home insurance, health insurance, or business insurance.
02
Policyholders providing information: In some cases, policyholders may be required to submit a statement of insurance even if they are not filing a claim. For example, when renewing or making changes to an existing policy, the insurance company may request an updated statement.
03
Insurance professionals: Insurance professionals, such as agents or adjusters, may also need a statement of insurance to gather information when assisting clients with claims. They use this information to assess coverage, process claims, or investigate incidents.
If you are uncertain whether you need to fill out a statement of insurance or need assistance in completing one, it is best to consult your insurance provider or seek guidance from a knowledgeable insurance professional.
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The statement of insurance is a document that provides information about the insurance coverage and policies held by an individual or organization.
Individuals or organizations who have insurance coverage are required to file a statement of insurance.
To fill out the statement of insurance, you need to provide details about your insurance policies, including the type of coverage, policy numbers, and insurance providers.
The purpose of the statement of insurance is to provide proof of insurance coverage and ensure that individuals or organizations meet the necessary insurance requirements.
The statement of insurance must include information such as the type of insurance coverage, policy numbers, insurance providers, and effective dates of the policies.
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