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STATEMENT OF INSURED ON POLICIES ISSUED UNDER THE ALABAMA SURPLUS LINES INSURANCE LAW [Revised 04.2013] Surplus Lines Carrier: Insured: Policy Number: Effective Date:Policy Issue Date: The undersigned

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How to fill out written statement of insured

01

Start by writing your full name and contact information at the top of the form.

02

Include the date and time of the incident that you are filing a claim for.

03

Provide details about the incident including what happened, where it took place, and the extent of any injuries or damages.

04

Be sure to include any relevant supporting documentation such as photos or witness statements.

05

Sign and date the statement to certify that the information provided is true and accurate.

Who needs written statement of insured?

01

Anyone who has experienced an incident that they believe is covered by their insurance policy may need to fill out a written statement of insured.

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What is written statement of insured?

The written statement of insured is a document where the insured provides details about an insurance claim.

Who is required to file written statement of insured?

The insured party is required to file the written statement of insured.

How to fill out written statement of insured?

The insured should provide all necessary information about the insurance claim, including date, time, location, and nature of the event.

What is the purpose of written statement of insured?

The purpose of the written statement of insured is to provide the insurance company with detailed information about the claim.

What information must be reported on written statement of insured?

The insured must report details such as date, time, location, and nature of the event leading to the claim.

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