Sworn Statement of Loss, Vehicle(Download)TO: ____________________Regarding: __________________Policy number: __________________Policy period: _________________ to __________________By the above-mentioned policy of insurance, you insured __________________, (hereinafter called the insured) against loss or damage to the automobile described as follows:Model Year: __________________Make: ________________Type of body: _________________VIN: ___________________State/License number: _______________ _________A loss caused by __________________ occurred on ________________, about the hour of _________________ __________, as follows:__________________The insured was the sole owner of the automobile at the time of the loss or damage and no other person had any interest therein, by lease, bailment, m