Sworn Statement of Loss(Download)Date policy issued: ___________________Date policy expires: __________________To the ___________________________________. At time of loss, by the above indicated policy of insurance you insured:_________________________________________________________ against loss by __________________________, upon the property described by the under Schedule “A,†according to the terms and conditions of the same policy and all forms, endorsements, transfers and assignments attached thereto.Time and origin: A ____ loss occurred about the hour of ____ __m., on the _______. The cause and origin of said loss were:_______________________________________________________________Occupancy: The building described or containing the property described, was occupied at the time o