Affidavit Of No Insurance Form Florida

Florida insurance affidavit under penalty of perjury i name of insured certify that i have personal iniury protection propetty damage liability and when required bodily iniurv liability insurance currently in effect with policy number under name of insurance company covering the following motor vehicle.

Affidavit of no insurance form florida. Company code number 5 digits. It is to be used when a patient is treating at your office and wants to submit pip bills through another person s insurance policy. 3 26 2008 2 25 30 am. Florida insurance affidavit under penalty of perjury i certify that i have name of insured personal injury protection property damage liability and when required bodily injury liability insurance currently in effect with under.

Form affidavit of non ownership please see the attached non ownership of motor vehicle affidavit. Microsoft word affidavit of no insurance 032008 doc author. I certify that the foregoing statements made by me are true. Brian french created date.

Failure to maintain the required coverage could result in suspension of your driver license license plate and registration. Signature of insured pursuant to s. Form affidavit of non ownership ovadia law group p a.