Is an electronic signature valid here?

Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are met.

Do I always need a notary?

Not necessarily. Notarization depends on lender, state law, or closing requirements. Check the requesting party’s instructions and state rules for acknowledgements or witness needs.

What if I entered the wrong policy number?

Correct the form promptly and re‑submit with a signed amendment or replacement. Provide the declarations page to support the corrected entry and prevent verification delays.

Can a lender force‑place flood insurance?

Yes. If the borrower fails to provide proof of required flood insurance, the lender may purchase force‑placed coverage and charge the borrower for premiums.

How do I revoke or amend an affirmation?

Provide a signed replacement or formal written amendment. If changes affect underwriting or closing, notify the lender and insurer immediately to document the updated status.

Who should retain the completed form?

The lender or servicer typically keeps the original in the loan file; retain copies per retention rules and regulatory guidance described earlier.

Electronic Signature
Templates
Insurance
Insurance Flood Affirmation

Insurance Flood Affirmation

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

INSURANCE FLOOD AFFIRMATION

Applicant / Insured Information

Applicant Name

Date of Birth:

Telephone:

Mailing Address Email Address

Policy Details

Insurer:

Policy Number

Policy Type:

Policy Period: From to

Coverage Limit:

Deductible:

Annual Premium:

Insured Property / Location

Insured Property Address

Occupancy Type:

Year Built:

Building Elevation (if known): Flood Zone Designation:

Flood Exposure and History

Prior flood claims on this property within the last ten years:

Yes No If Yes, provide dates, claim numbers and brief description

Flood Protection & Mitigation Measures

Indicate any protective measures currently in place at the insured property:

Elevated structure above base flood elevation Permanent flood barriers/levee Sump pump and drainage improvements Other (specify below) Describe other mitigation measures

Exclusions, Limitations & Acknowledgements

By signing this Flood Affirmation, the Applicant acknowledges and agrees to the following representations and limitations:

1. The Applicant affirms that all statements in this document are true, complete and correct to the best of the Applicant's knowledge. Any material misrepresentation, omission or concealment of fact may void coverage or be a basis for denial of a claim.

2. Flood coverage is limited to the terms, conditions, limits and deductibles shown in the policy. This affirmation does not amend, extend or alter the policy language. Coverage for flood perils is subject to specified exclusions, including but not limited to loss resulting from earth movement when not caused by flood, wear and tear, or intentional acts.

3. The Applicant authorizes the insurer, its agents and representatives to obtain and verify information from public records, flood maps, elevation certificates and claims databases to determine flood exposure and history.

4. The Applicant understands that certain properties located in high-risk zones may require elevation certificates or additional mitigation to be eligible for specific coverages, and that failure to disclose known flood vulnerabilities may affect claim settlement.

5. Fraud Warning: Any person who knowingly presents false, incomplete or misleading information for the purpose of defrauding an insurer may be subject to civil and criminal penalties under applicable law.

Beneficiary / Payee for Claim Proceeds (if different from Applicant)

Beneficiary / Payee Name

Relationship to Applicant:

Percentage of Proceeds:

Supporting Documentation Checklist

Attach copies of applicable documentation. Check all items provided or to be provided with this affirmation:

Proof of ownership / deed Elevation certificate (if available) Photographs of property and damage (if applicable) Repair estimates / contractor bids Official flood map or letter of map amendment Other supporting documents (describe below) If Other, describe documents provided

Incident / Loss Details (if claiming)

Date of Loss:

Brief Description of Loss / Damage

Declaration and Certification

I, the undersigned Applicant, certify under penalty of perjury that I have read and understand the statements in this Flood Affirmation. I declare that the information provided herein is true, accurate and complete to the best of my knowledge. I understand that the insurer will rely upon this affirmation in evaluating eligibility, underwriting and claim determinations. I authorize the insurer and its representatives to obtain records and to make inquiries as necessary to verify any information contained in this form.

I acknowledge that submission of this affirmation does not constitute proof of coverage for any particular loss and does not change or expand the policy terms and conditions. I understand that failure to disclose material information or intentional misrepresentation may result in denial of coverage and may subject me to civil and criminal penalties.

Printed Name:

Signature:

Date:

By signing above, the Applicant affirms that the statements in this Flood Affirmation are true and acknowledges the fraud warning and authorization provisions set forth herein.

What the Insurance Flood Affirmation Is and When it Matters

An Insurance Flood Affirmation is a written declaration used to confirm whether a property is covered by flood insurance, to report policy details, or to state that no flood policy exists. Lenders, insurers, title companies, and property owners commonly use it during loan underwriting, real estate closings, renewals, and insurance audits. The form captures property identifiers, policy number, insurer name, coverage limits and effective dates, and it usually requires a signature. Electronic completion and eSigning are widely accepted for this affirmation when the signature meets applicable e‑signature rules.

Why an Insurance Flood Affirmation Matters

Completing this affirmation creates a clear record for lenders, insurers, and closing agents, reduces escalation over coverage status, and helps avoid force‑placed policies and closing delays.

Who Typically Completes an Insurance Flood Affirmation

The document is used by multiple parties across lending, brokerage, and insurance workflows.

Lenders and loan servicers — verify flood coverage for mortgage collateral and determine escrow requirements for premiums.
Title companies and real estate agents — confirm insurance status before closing and record exceptions in closing statements.
Property owners and insurance agents — provide policy details, update coverage dates, and attest to current protection or lack thereof.

Each signer’s role determines which fields they complete and which authentication or notarization steps apply.

Step-by-step: Completing the Insurance Flood Affirmation

Follow these steps in order to collect accurate data, obtain required signatures, and deliver the completed affirmation to the requesting party.

01

Gather documents: Locate policy declarations page and mortgage loan number.
02

Verify property: Confirm street address, legal description, and parcel ID.
03

Complete fields: Enter insurer, policy number, effective and expiration dates.
04

Sign and submit: Apply required signature or notary; send to lender or insurer.

How the electronic submission workflow typically flows

A standard eSubmission route shortens turnaround: upload, assign, authenticate, sign, and distribute the completed affirmation.

Upload form: Sender uploads PDF or DOCX.
Assign signers: Enter signer emails and roles.
Authenticate signer: Use email, SMS code, or stronger ID.
Deliver signed copy: Recipients receive PDF and audit trail.

Recommended settings for online completion and routing

Configure the template to capture required data, enforce authentication, and route completed copies to stakeholders automatically.

Field	Configuration
Authentication	Email + optional SMS OTP or KBA for high risk
Conditional fields	Show policy detail fields only if 'Has Policy' selected
Consumer disclosure	Include ESIGN disclosure for consumer‑facing forms
Routing order	Send to insurer, then lender, then owner

Technical considerations for electronic signing and storage

Choose a platform that supports secure PDFs, audit trails, and the authentication methods your stakeholders require.

File formats: PDF, DOCX, and image support
Integrations: CRM, loan origination, cloud storage
Security: AES-256 at rest, TLS in transit

Key risks and potential consequences of incorrect affirmations

Loan delays: Closing postponed

Force‑placed insurance: Higher premiums charged by lender

Claim denial: Coverage disputes with insurer

Regulatory exposure: Potential compliance review

Financial loss: Uninsured flood damage costs

Reputational harm: Trust erosion with clients

Common mistakes to avoid when preparing the affirmation

Entering an incorrect policy number or insurer name, which prevents automated verification and causes underwriter follow‑up.
Using an incomplete property description or wrong mailing address, leading to mismatches with loan or title records.
Failing to sign, date, or notarize when requested, resulting in delayed closings or force‑placement of coverage.
Omitting coverage dates or providing expired policy information, which can trigger immediate lender action.

Essential data elements to collect on the form

Property Address: Street, city, state, ZIP

Policy Number: Exact insurer policy ID

Insurer Name: Carrier legal name

Coverage Limits: Declared limit amounts

Coverage Dates: Effective and expiration dates

Signature Date: MM/DD/YYYY format

Core sections to include in a professional Insurance Flood Affirmation

A complete form groups identifying data, policy details, attestation language, signature and notarization, and routing instructions for verification.

Affirmation Statement

Clear attestation language stating whether the property is insured for flood, including a clause that false statements may have consequences under applicable law.

Property Description

Precise street address, legal description or parcel ID, and any unit or condominium identifiers required by title or lender.

Policy Details

Insurer name, full policy number, coverage limits, premium amount if requested, and effective/expiration dates for verification.

Signature and Date

Block for the insured’s printed name, signature, and date; specify whether electronic signatures are accepted and the required format.

Notary / Witness Block

Notary acknowledgement or witness signatures when required by state law or the requesting lender; include spaces for stamp and journal entry.

Verification Routing

Instructions for returning the completed form and any supporting declarations pages to the lender, insurer, or title company, and retention requirements.

Common timeframes and deadlines for submission

Timely submission prevents force‑placed insurance and closing delays; follow deadlines set by lenders or closing agents.

At application:

Provide affirmation during loan application when requested

Before closing:

Submit final affirmation prior to settlement to avoid delays

Upon renewal:

Update affirmation when flood policy renews or changes

After claims:

Provide post‑loss coverage details within insurer timeframes

On lender request:

Respond within the lender’s stated timeline to avoid force‑placement

eSignature vendor comparison for processing Insurance Flood Affirmations

Comparison focuses on starting price, trial availability, bulk send capability, audit trail presence, and HIPAA compliance. signNow is listed first per vendor ordering rules.

	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 free trial	Free trial available	Free trial available	Free trial available	Free trial available
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

FAQs and troubleshooting for the Insurance Flood Affirmation

Answers to common questions on validity, notarization, corrections, and what to do if coverage lapses.

Need help? Contact support

Is an electronic signature valid here?
Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and reliable record retention are met.
Do I always need a notary?
Not necessarily. Notarization depends on lender, state law, or closing requirements. Check the requesting party’s instructions and state rules for acknowledgements or witness needs.
What if I entered the wrong policy number?
Correct the form promptly and re‑submit with a signed amendment or replacement. Provide the declarations page to support the corrected entry and prevent verification delays.
Can a lender force‑place flood insurance?
Yes. If the borrower fails to provide proof of required flood insurance, the lender may purchase force‑placed coverage and charge the borrower for premiums.
How do I revoke or amend an affirmation?
Provide a signed replacement or formal written amendment. If changes affect underwriting or closing, notify the lender and insurer immediately to document the updated status.
Who should retain the completed form?
The lender or servicer typically keeps the original in the loan file; retain copies per retention rules and regulatory guidance described earlier.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now