Establishing secure connection…Loading editor…Preparing document…

Insurance Affidavit of No Insurance

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE AFFIDAVIT OF NO INSURANCE

Affiant Information

Client Name:

Date of Birth:     Driver's License / ID #:

Affidavit

State of:     County of:

I, the undersigned Affiant, being duly sworn, certify under penalty of perjury that I have no active insurance coverage for the types of risk indicated below with respect to the subject matter identified in this affidavit. I affirm that I have made a diligent inquiry and that the statements contained in this affidavit are true and correct to the best of my knowledge.

Coverage Declaration — No Insurance

I affirm that I do NOT have active insurance coverage for the following types (check all that apply):









Policy Details (If Applicable)

Insurer Name (if any):

Policy Number:     Policy Period From: To:

Reason for No Insurance





Loss Information (If Applicable)

Date of Loss / Incident:

Supporting Documentation

I have attached or will provide the following documents to support this affidavit (check all that apply):





Certification and Penalty Notice

I declare under penalty of perjury under the laws of the State named above that the foregoing statements are true and correct. I understand that knowingly making a false statement in this affidavit may constitute a criminal offense and may subject me to civil liability, including fines and penalties, and the denial of any claims or benefits for which this affidavit is submitted.

I further acknowledge that this affidavit may be relied upon by insurers, claimants, governmental entities, and courts, and that I am responsible for providing any additional documentation or testimony necessary to support the statements contained herein.

Acknowledgment

By signing below, I affirm that I am the person named in this affidavit and that I have the authority to make these statements. I understand this affidavit must be completed in full and may be subject to verification.

Affiant Printed Name:

Signature:

Date:

Subscribed and sworn before me (notary public or other authorized official) on the date shown. Notary acknowledgment, seal, and signature to be completed by the official at the time of notarization.

Enter text✕
Prepare your document for signing right on this page
  • 01 Edit the text and complete the fields
  • 02 Click Sign Now and on the next screen add recipients and signature fields in SignNow
  • 03 Start your free trial to sign and send your doc
Sign Now

What the Insurance Affidavit of No Insurance Is

An Insurance Affidavit of No Insurance is a sworn written statement, signed under penalty of perjury, asserting that a named party does not have a specified insurance policy or coverage in place. The affidavit typically identifies the parties, describes the risk or contract at issue, names the insurer that is absent or the policy type not held, and includes a signature block and notarization or electronic authentication. Organizations use it where proof of insurance is required but coverage cannot be produced, or when a counterparty needs formal confirmation that no policy exists for a particular risk or period.

Why this affidavit matters for transactions and compliance

The affidavit provides a formal, recordable declaration that a party lacks specified insurance, creating an auditable statement for contracting, claims handling, or regulatory review. It reduces uncertainty for counterparties, supports risk assessments, and can trigger alternative coverage or indemnity arrangements.

Why this affidavit matters for transactions and compliance

Who typically prepares or requests this affidavit

The document serves internal recordkeeping and external confirmation functions; the requester should record why the affidavit was accepted in lieu of insurance.

  • Contract Managers verifying vendor prerequisites or exceptions.
  • Claims Adjusters documenting absence of policy in loss investigations.
  • Procurement and Compliance teams confirming bidder insurance qualifications.

Core elements to include in a professional affidavit

A complete affidavit of no insurance is concise but specific, enabling third parties to rely on it. Include identifying facts, a clear affirmative statement denying coverage, dates and periods covered, the factual basis for the assertion, signature and notarization or electronic signature evidence, and a contact for follow-up verification.

Caption

Document title, jurisdiction, date, and case or contract reference so the affidavit is plainly connected to the matter at hand.

Declarant Identity

Full legal name, job title, employer or business entity, and contact details to attribute the statement to a responsible person.

Statement of No Insurance

A clear, affirmative sentence that no insurance policy of the specified type exists for the named period or risk.

Scope and Dates

Exact coverage period or incident date(s) referenced so the denial is limited and unambiguous.

Factual Basis

Short explanation of how the declarant knows (e.g., records search, insurer confirmation) to support credibility.

Authentication

Signature block with date, notarization or remote online notarization details, and any witness lines if required.

How to complete the affidavit step by step

Follow these steps in order to produce a clear, verifiable affidavit suitable for contract or claims use.

  • 01
    Gather records: Collect company insurance registers, broker confirmations, and insurer portal screenshots.
  • 02
    Draft statement: Write a concise affirmative denial referencing the exact policy type and dates.
  • 03
    Include supporting facts: Add a short statement of how the declarant knows the policy does not exist.
  • 04
    Authenticate: Sign, notarize or use remote notarization, and retain the completed affidavit with your file.

Configure an online workflow for affidavit completion

Set up digital routing to ensure consistent completion, authentication, and record retention when using electronic tools.

Field Configuration
Declarant name Required text field with ID verification step
Insurance details Conditional fields for insurer, policy type, and dates
Supporting evidence Attach file or URL field for proofs (portal screenshots, broker email)
Authentication Require signer authentication and optional notarization workflow

Where completed affidavits are sent and stored

After signing and notarization, route the affidavit to stakeholders and preserve it in secure records with an audit trail.

  • Requestor: Send final copy to the party who requested the affidavit for their contract or claim file
  • Internal Records: Store in the declarant's compliance or insurance folder with indexing
  • Insurer or Broker: Provide to insurer or broker when used to confirm absence of coverage
  • Notary Retention: Notary or RON provider retains required journal entry and recording if applicable

Digital signing and eSubmission considerations

Ensure chosen systems preserve a tamper-evident signed PDF and meet applicable legal standards such as ESIGN (15 U.S.C. ch. 96) and state UETA rules.

  • Authentication: Email link, SMS code, or stronger KBA/SSO for higher-assurance signings
  • Audit Trail: Capture timestamp, IP, and signer actions to evidence intent
  • RON Support: Platform must support video recording, ID proofing, and journal storage for legal RON

Timing and processing expectations

Processing typically depends on notarization and any verification steps; remote workflows can shorten turnaround but must meet legal proof standards.

Immediate:

Draft and sign once records search is complete

Notarization window:

Same-day notarization possible; RON sessions may require scheduling

Recipient processing:

Counterparty review often occurs within 1–5 business days

File retention:

Record kept indefinitely per company policy and regulatory need

Dispute response:

Allow additional 30–90 days for verification in contested matters

Common mistakes to avoid

  • Vague scope: failing to specify policy type or dates creates ambiguity and weakens reliance.
  • Insufficient basis: asserting no insurance without documented records or broker confirmation invites challenge.
  • Signature errors: unsigned or improperly notarized affidavits may be rejected by counterparties or courts.
  • Retention gaps: failing to retain supporting evidence (screenshots, emails) undermines future verification.

Legal risks and consequences of incorrect affidavits

Perjury risk: False statement may expose declarant to perjury or civil liability
Contractual liability: Counterparty reliance on a false affidavit can trigger indemnity or breach claims
Insurance consequences: Providing incorrect facts to insurers or regulators can affect future coverage
Evidence exclusion: Improperly authenticated affidavits may be inadmissible in court
Operational delays: Challenges to affidavit accuracy can delay claims or contract performance
Regulatory fines: Statutory penalties may apply where affidavits affect regulated filings or benefits

Example scenarios where an affidavit is used

Real-world examples show how the affidavit supports different administrative and legal processes.

Vendor Contract Exception

A procurement officer requests an affidavit when a small vendor lacks commercial auto coverage

  • The vendor's COO attests after a broker search confirms no policy
  • The affidavit allowed the parties to document the exception and require specific indemnity language in the contract.

Claims Investigation

An adjuster needs evidence an insured had no umbrella policy for an incident date

  • The insured's insurance manager signs an affidavit describing the records searched
  • The affidavit helped close the coverage analysis and proceed with claim allocation.

Representative eSignature pricing and capability comparison

Basic vendor pricing and common capability indicators for eSignature solutions. signNow is listed first per platform comparison conventions.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about affidavits of no insurance

Answers to common questions about validity, notarization, and electronic completion of an Insurance Affidavit of No Insurance.


Need help? Contact support

be ready to get more
Join over 28 million airSlate SignNow users
Sign Now
Company
Forms
Pricing
Resources
Knowledge base
Other Products
© 2026 airSlate Inc. All rights reserved.