Affidavit Of No Insurance Form Pa

An affidavit of no other insurance is a statement from the car owner or car driver stating that he or she has no other coverage such as an umbrella policy that could be used today compensation for a given car accident.

Affidavit of no insurance form pa. Brian french created date. 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. Application for executive officer exception from the provisions of the pennsylvania workers compensation act. The affidavit is a legal document signed under oath or an affirmation.

Insurance information applicant is a contractor within the meaning of the pennsylvania workers compensation law. A copy of an application for insurance to the pennsylvania assigned risk plan which contains all information required to appear on the id card excluding the policy number and is signed by a licensed producer insurance agent. Complete this form to register your insurance carrier with the state of pennsylvania. From the state workers insurance fund 570 963 4635 or through an insurance company click here for a list of insurance companies licensed to conduct business in pa or by securing department of labor and industry approval to self insure individually or as a group for more information contact 717 783 4476.

An affidavit of no insurance is a written statement made by a person verifying that he does not have liability insurance covering a claim or lawsuit filed against him for injuries or property damage. If they cannot provide proof in the form of any acceptable forms of insurance they will be required to serve the suspension or. 3 26 2008 2 25 30 am. Pennsylvania notice of insurance.

0 found this answer helpful 1 lawyer agrees. Insurance carrier for coverage of medical services. Affidavit must be notarized workers compensation insurance coverage a. This small estate affidavit can be filed when 60 days 2 months have passed after a loved one passes away and as long as no other written claim for the money including a last will and testament or a probate order have been filed with the insurance company.

I certify that the foregoing statements made by me are true. Whether or not a final will and testament has gone to probate court the family or other successors of a loved one who passed away may file an affidavit of heirship small estate affidavit or small estate insurance only affidavit to have the decedent s property and finances distributed. In pennsylvania a court will decide this distribution with or without probate also being involved with or without a will although this generally pertains to property not listed in the will or if.