The Insurance Affidavit is a crucial document in Indonesian insurance practice that serves as a formal, sworn statement providing verified information about insurance-related matters. This document type is commonly used when formal verification of insurance-related facts is required, such as during claims processing, policy disputes, or regulatory compliance procedures. The affidavit must be executed in accordance with Indonesian law, particularly Law No. 40 of 2014 on Insurance and relevant OJK regulations, and requires notarization to be legally valid. Insurance Affidavits can be used across various scenarios, including but not limited to confirming policy details, documenting loss circumstances, verifying beneficiary information, or attesting to the authenticity of insurance-related documents. The content and format must comply with Indonesian legal requirements for sworn statements while addressing specific insurance-related matters at hand.
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1. Title and Jurisdiction: Clearly states this is an Insurance Affidavit and the jurisdiction (Indonesia)
2. Affiant Information: Full legal name, identification details, address, and capacity of the person making the affidavit
3. Oath Declaration: Formal declaration that the statements are being made under oath and subject to penalties of perjury
4. Insurance Policy Details: Specific information about the insurance policy including policy number, type, issuer, and relevant dates
5. Statement of Facts: Detailed enumeration of the facts being sworn to, presented in clear, numbered paragraphs
6. Supporting Evidence Reference: References to any supporting documents or evidence being attached to the affidavit
7. Verification Statement: Affiant's confirmation that all stated information is true and correct to the best of their knowledge
8. Execution Block: Space for affiant's signature, date, and notary's authentication
1. Additional Witness Statements: Section for additional witnesses to provide supporting sworn statements, used when multiple parties need to testify to the same facts
2. Prior Claims History: Details of any previous insurance claims, used when relevant to the current affidavit
3. Medical Information: Specific section for health-related information, used in health insurance or injury-related affidavits
4. Property Details: Detailed description of property, used in property insurance-related affidavits
5. Financial Loss Statement: Detailed breakdown of financial losses, used in claims-related affidavits
1. Schedule A - Supporting Documents: List and copies of all referenced supporting documents (insurance policies, correspondence, etc.)
2. Schedule B - Photographic Evidence: Photographs or visual evidence referenced in the affidavit, if applicable
3. Schedule C - Official Reports: Copies of any official reports (police reports, medical reports, etc.) referenced in the affidavit
4. Schedule D - Correspondence: Copies of relevant correspondence with insurance companies or other parties
5. Appendix 1 - Certified Translations: Official translations of any documents not in Indonesian or English, if required
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