Affidavit Of No Insurance Form Geico

Affidavit of no insurance i due hereby swear that i have no medical health insurance print name for payment of medical bills associated with my injury sustained during my participation in intercollegiate athletics.

Affidavit of no insurance form geico. I certify that the foregoing statements made by me are true. I do hereby testify under the penalties of perjury that the information contained within this affidavit is true and correct to the best of my knowledge and belief. To complete this form properly please provide all requested information sign and date and include any medical bills you have received when you return the application to geico. If this is not true you should contact a lawyer to discuss further.

If this is true feel free to sign. Brian french created date. Insurance carrier for coverage of medical services. 2020 case opinion from the southern district of mississippi us federal district court.

Geico insurance et al no. On the date the accident occurred i personally did not own an automobile with liability insurance coverage that would afford me personal injury protection no fault benefits. Then they ask if any other member has a different insurance policy. 3 26 2008 2 25 30 am.

When you click continue you will be taken to their website which is not owned or operated by geico. Norman et al v. I hereby state that i am not qualified to collect for medical benefits under the policy of any relative with whom i may. I received a affidavit from geico that say geico has been served with a demand for disclosure of your coverage limits applicable to this loss on date you were covered with bodily injury 100 300 and property damage of 50.

To complete this form properly please provide all requested information sign and include any medical bills you have received when you return the application to geico. The vehicle i was driving was not covered by any policy of insurance. Microsoft word affidavit of no insurance 032008 doc author. Geico has no control over their privacy practices and assumes no responsibility in connection with your use of their website.

Geico insurance agency inc. The affidavit is simply a statement confirming you have no significant assets to go after personally and that no other insurance policies were in effect except your geico policy. Has partnered with to provide insurance products. The application for motor vehicles no fault benefits is your formal application for benefits under the no fault law.