Statutory declarations
Statutory Declaration in Support of an Insurance Claim
A sworn declaration setting out the facts of an insurance claim — used to support a claim for loss, theft, damage, or benefits. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
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Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Insurance Claim Affidavit
- Proof of Loss Declaration
- Sworn Statement for an Insurance Claim
+2 more names
- Declaration in Support of a Claim
- Statement of Loss Affidavit
STATUTORY DECLARATION IN SUPPORT OF AN INSURANCE CLAIM
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the holder of policy number with ______.
On or about ______, the following loss or damage occurred: ______.
Estimated value of the loss (if known):
The information set out above is true, and I have not exaggerated or misrepresented any part of this claim.
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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Statutory Declaration in Support of an Insurance Claim
A compact preview of this template
01Your Information
Your full legal name
Insurance company
Your full address
STATUTORY DECLARATION IN SUPPORT OF AN INSURANCE CLAIM
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the holder of policy number with ______.
On or about ______, the following loss or damage occurred: ______.
Estimated value of the loss (if known):
The information set out above is true, and I have not exaggerated or misrepresented any part of this claim.
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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Overview
About this document
- 01
What is an insurance claim declaration?
It is a sworn statement — also called an insurance claim affidavit or proof of loss declaration — in which you set out, under oath, the facts your insurer needs to assess a claim.
A sworn account helps the insurer rely on your description of the loss and the circumstances.
- 02
When you might need one
Insurers request it across many types of claims.
- A claim for lost, stolen, or damaged property.
- A benefit or accident claim requiring a sworn account.
- Confirming the facts and value of a loss for the insurer.
- 03
What to include
Describe what happened, the date and place, the items or loss involved, and any values. Keep supporting records — receipts, photos, a police or incident report — available, as the insurer may ask for them with the declaration.
Follow your insurer’s instructions; they may also have their own proof-of-loss form to complete.
- 04
How to notarize a insurance claim declaration in Ontario
After you fill in your insurance claim declaration and download the PDF, do not sign it in advance. A sworn document must be signed in front of a notary public or commissioner for taking affidavits, who administers your oath or solemn affirmation first.
Minute Notary commissions your insurance claim declaration online by secure video, under Ontario's remote commissioning rules (O. Reg. 431/20), or in person in Ottawa. Bring valid government-issued photo identification so we can verify your identity before applying the notary seal.
Good to know
Before you fill it in.
Short notes from our notary on this template. Worth a minute before you start.
- 01
Reviewed for use in Ontario by a notary public and commissioner for taking affidavits.
- 02
Fill it in online for free and download a ready-to-sign PDF — no account required.
- 03
Sign in front of the notary, who administers your oath or affirmation and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Statutory Declaration in Support of an Insurance Claim
- When does an insurer need a sworn declaration?
- Often for claims involving lost, stolen, or damaged property, or benefit and accident claims, where the insurer wants a sworn account of the facts and the loss.
- What should I include?
- What happened, the date and place, the items or loss involved, and any values. Keep receipts, photos, and any police or incident report available.
- Can I notarize it online in Ontario?
- Yes. You can swear it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- Does this replace my insurer’s form?
- Not necessarily. Follow your insurer’s instructions, as they may also require their own proof-of-loss form.
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